Attendee Registration

Attendee Registration

Please complete one form per camper.
Camper's Full Name

First NameLast Name
Age
Gender
Phone Number (if over 18)
Please enter a valid phone number.Format: (000) 000-0000.
Email Address (if over 18)
example@example.com
Home Church
Pastoral Reference (if first year attending)
Name and Phone Number
Name(s) of Camper(s) You Prefer to Room With
Parent Contact (if under 18)

First NameLast Name
Parent Phone Number (if under 18)
Please enter a valid phone number.Format: (000) 000-0000.
Parent Email (if under 18)
example@example.com
Does the camper have any allergies or medical conditions we should be made aware of?
We regret that we cannot provide alternative meal plans for those that are allergic to standard ingredients such as gluten, peanuts, dairy, etc.
Does the camper take any daily medications we should be made aware of?
Emergency Contact Name
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.

Photo Release

The Church on the Square has my permission to use my or my child’s photographed image publicly for promotional purposes. I understand that the images may be used in print publications, online publications, presentations, websites, and social media. I also understand that no royalty, fee, or other compensation shall become payable to me by reason of such use.
Signature of Camper (or Parent if camper is under 18)

Retreat Fee
The fee for the retreat is $150 (per camper). Please remit payment through one of the following payment platforms.

Venmo: cotsgeorgetown@gmail.com

Paypal: cotsgeorgetown@gmail.com

If you wish to pay by check, please contact Pastor Bradley at 512-300-7452.
Financial assistance is available for those in need. Please enter the amount you can contribute.
Should be Empty:

Retreat Fee