Camp ACCOVAC Spring Retreat 2026

Camp ACCOVAC Spring Retreat 2026

Please complete the following registration form in its entirety. If any information is left blank, you will be asked to provide the information at drop off, or your camper will not be permitted to participate in activities at Camp ACCOVAC.
April 10-12, 2026

Camp ACCOVAC

33021 Mountain Valley Rd

Millboro, VA 24460

540-997-5964

campaccovac@yahoo.com

Ages 6th - 12th Grade

Weekend Director: Cooper Rice

Space is given on a first come, first serve basis.

COST: $25 per camper, due at registration

ARRIVAL: Friday, April 10 between 6-7 PM

DEPARTURE: Sunday, April 12 @ 10:00 AM (or before if you need to get to church)

ITEMS TO BRING:

Bible
Soap, Shampoo, Personal Items
Towel & Washcloths
Warm clothes (it could get pretty cold at spring retreat)
Regular clothes (it could get pretty hot during spring retreat)
Athletic shoes for games
Sandal or shower shoes for the shower
Boots or old shoes to work in
An old outfit for working
Sleeping bag & Twin fitted sheet
Pillow

ITEMS TO LEAVE AT HOME:

All electronic devices
Tightfitting, suggestive, or revealing clothes
Weapons of any kind
Skateboards or Rollerblades
Tobacco products
Matches or lighters
Anything illegal
Anything of high value
Snacks and Drinks (We provide those and do not allow those in rooms)

CAMP ACCOVAC IS A PHONE FREE CAMP! NO ELECTRONIC DEVICES ARE ALLOWED!

We do have a camp phone if you need to speak to your camper or if they need to speak to you. That is not a problem at all!
CAMPER INFORMATION
Camper Name*

First NameLast Name
Camper Birth Date

MonthDayYear
Camper Gender*
Current Grade In School*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
PARENT INFORMATION
Parent/Guardian #1 Name*

First NameLast Name
Parent/Guardian #1 Phone Number*
Please enter a valid phone number.
Parent/Guardian #1 Email*
example@example.com
Parent/Guardian #2 Name

First NameLast Name
Parent/Guardian #2 Phone Number
Please enter a valid phone number.
Parent/Guardian#2 Email
example@example.com
Emergency Contact (please provide someone we can contact in case we cannot reach you)*

First NameLast Name
Emergency Contact Phone Number*
Please enter a valid phone number.
Emergency Contact Relation to Camper*
ROOM ASSIGNMENTS

Please indicate if there is a specific person who you know is coming to the retreat that you would prefer to room with. We cannot guarantee that you will room with that person but we will do our best to make sure you room with who you prefer.
Preferred Roommate Name

First NameLast Name
MEDICAL RELEASE

We WILL have a licensed nurse on campus at all times!
Please list all allergies including season, food, medicines, etc. (N/A if none)*
Please list all medications that your camper will be bringing with them and the directions, i.e. when the medication should be taken and dosage. (All medications including over the counter need to be turned into the camp nurse upon arrival)
OVER THE COUNTER MEDICATION
In case your camper may need over the counter medication, please indicate which of the following options you prefer.*

I give Camp ACCOVAC's nurse permission to give over the counter medications to my camper with no reservations or restrictions.Please do not give my camper any over the counter medications for any reason.My camper can have over the counter medications, but please check with me first.
Medical Disclaimer

We do not require your insurance or medicaid information for this retreat; however, if there is a need to take your camper to the emergency room, we will contact you on the way to the hospital (or before if the emergency is not major). Typically, the hospital will call the parents to get permission to treat the patient but they will not ask for permission if it is a major emergency. The in-take at the hospital will call for insurance and/or medicaid information.
PHOTO RELEASE: I give permission to Camp ACCOVAC to take my camper's picture while they are at camp. I understand that these pictures may be used for promotion or advertisement purposes and may appear on the ACCOVAC website, brochures, Facebook, and/or Instagram.*

YesNo
REMINDER:

Please make all checks payable to Camp ACCOVAC.

We accept cash but cannot process online payments at the moment.
Please type your full name confirming that you approve of the submission of this registration form.*
Should be Empty:

Camp ACCOVAC Spring Retreat 2026

CAMPER INFORMATION

PARENT INFORMATION

ROOM ASSIGNMENTS

MEDICAL RELEASE

OVER THE COUNTER MEDICATION

Medical Disclaimer