Camp ACCOVAC Junior Fall Retreat 2026

Camp ACCOVAC Junior Fall 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.
September 18-20

Camp ACCOVAC

33021 Mountain Valley Rd.

Millboro, VA 24460

540-997-5964

campaccovac@yahoo.com

Ages: 2nd Grade - 7th Grade

Weekend Director: Cooper Rice

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

Cost: $50 Per Person Due At Registration!

ARRIVAL: Friday September 18 between 6-7 PM

DEPARTURE: Sunday September 20 @ 10:00 AM or before

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
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's Date of Birth

MonthDayYear
Camper's Gender
Camper's Current Grade in School
Preferred Cabin Mate
Address

Street Address

Street Address Line 2

CityState / Province

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

First NameLast Name
Parent/Guardian #1 Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian #1 Email
example@example.com
Parent/Guardian #2 Full Name

First NameLast Name
Parent/Guardian #2 Phone
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian #2 Email
example@example.com
EMERGENCY CONTACT

Please provide the name and contact of someone (who is not you) that we can contact in case of emergency.
Emergency Contact Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Relationship to Camper
MEDICAL RELEASE

We WILL have a licensed nurse on site 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.
MEDICAL INSURANCE INFORMATION
Medical Insurance Carrier
Policy/Group Number
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.
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 as your approval of the submission of this online registration form.

First NameLast Name
Should be Empty:

Camp ACCOVAC Junior Fall Retreat 2026

CAMPER INFORMATION

PARENT INFORMATION

EMERGENCY CONTACT

MEDICAL RELEASE

OVER THE COUNTER MEDICATION

MEDICAL INSURANCE INFORMATION

PHOTO RELEASE