Fall Retreat Student Sign-Up
Register your details to join the fall retreat.
Student Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Do you have any dietary restrictions?
Please list any medical conditions or allergies we should be aware of. List any meds your child is on. (Note- medications must be turned in to the camp nurse.)
Do you give permission for the nurse to treat simple ailments and give meds such as Tylenol, Benadryl, etc.?
Birthdate
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Home Church, pastor and/or youth pastor
Roommate Preference
STUDENT AGREEMENT As a student, I understand that this is a time set apart to seek God, grow in my faith, and be fully present. I agree to: Respect camp leaders and follow all instructions.Treat others with kindness and respect. Participate in services, activities and group times with a willing heart. Honor the atmosphere of worship and spiritual focus. Understand there are no drugs, alcohol or tobacco allowed. Understand I must honor God with my actions and words and that no cursing, perverse or hateful talk or fighting is allowed. Cell Phone Policy: Cell phones are permitted for photos and communication with family. However: There will be designated times when phones must be put away. Camp leaders may ask for phones to be set aside during services, sessions and specific activities. At no time is internet browsing, social media, or online activity permitted during camp. Modest clothing must be worn. No short spandex shorts, no crop tops, no low cut tops. If you agree, please check yes.
Yes
No
Sign Up
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