VBC Youth Fall Retreat 2026

Fall Retreat 2026

@Camp Crossroads in Lowesville, VA
When: October 23-25, 2025

Leave on Friday at **4:30pm** from church parking lot.

Return at 1:00pm to Vinton Baptist.

Where: Camp Crossroads in Lowesville, VA (2247 Little Piney Rd., Lowesville, VA)

https://www.crossroadscamp.com/

Cost: $125 Per person

For more questions contact Whitney: 540-343-7685 or whitney@vintonbaptistchurch.org
Sign Up Form
Student Name
Student Phone:
Please enter a valid phone number.Format: (000) 000-0000.
Sibling Name
Sibling Phone:
Please enter a valid phone number.Format: (000) 000-0000.
Sibling Name
Sibling Phone:
Please enter a valid phone number.Format: (000) 000-0000.
I'm coming as a friend! My friend is:
Parents Name
Parent Email
example@example.com
Parents Phone Number
Adult Chaperone
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Hoodie Sweatshirt Size (Adult Sizes Only) for all students and adults attending:
Cost for the weekend is $125. I will make payment via:
My student will not be able to stay the whole weekend. Please include detailed plans about late arrival or early departure. Please note, Camp Crossroads is almost 2 hours away!
Participants Details
Student's Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate

Emergency Contact
Emergency Contact Name

First NameLast Name
Phone Number
Relationship to Participant
Emergency Contact 2
Emergency Contact Name

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

Medical Details
Insurance Carrier
Policy Number
Policy Holder Address (if different from student):

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Place of Employment
Work Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Does your child have any dietary requirements, allergies or medical conditions we need to be aware of?
Please include any medication that needs to be given throughout the weekend.

Registration confirmation
I give permission for my child to be photographed and their image to be used in worship slides, church website or social media re: this event.
I give permission for my child to ride in the personal vehicle of church leaders who have received background checks and screenings.
By the issue of this letter I am authorizing the transportation, lodging, and feeding of participant named above. Should a medical emergency arise during a church activity or while traveling on such, I hereby grant permission to the activity leader or adult chaperone(s) to make whatever emergency arrangements are necessary, including the selection of physicians, paramedics, or other medical personnel and a hospital and/or clinic for the care of participant named above. I hereby give the medical personnel, hospital, and/or clinic my permission to hospitalize, treat, and to order injections, blood, anesthesia, or surgery as required for participant named above. I also understand that as a participant, my child may be photographed or videotaped during on- and/or off-campus activities, and these photos/videos may be used in promotional materials, group activities, and/or official church website. I, the undersigned, do hereby release and forever discharge Vinton Baptist Church, its employees, agents, and members from any and all claims past, present, and future, arising out of any illness or injury to participant named above. Further, I assume full financial responsibility for all physician, technician, medical, hospital, or other fees charged for such treatment.
Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty:

Fall Retreat 2026

Sign Up Form

Participants Details

Emergency Contact

Emergency Contact 2

Medical Details

Registration confirmation