Registration – Annual Youth Retreat

Camp

Name *

First

Last

Gender *

Age

Email *

Please enter your email, so we can follow up with you.

Address *

Residential Mailing Address

Phone

Do you plan on staying on campus or travel to camp? *

Are you a member of the Church of Christ? *

plan Kin: camp?

Medical Illnesses *

Food Allergies *

Please state any food allergies or dietary restrictions.

Any Special Instructions

Any additional information you’d like us to know

Please include their name and telephone number so we can effectively contact them in any event.

Next of Kin: Name *

Relationship to Camper *

Phone (Next of Kin) *