Registration – Annual Youth Retreat

Camp

Name *

First

Last

Gender *

Age *

Country Instructions Camper

Email *

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

Country and Parish *

Which country are you living in now? Please include your state/parish

Phone *

How many days do you plan on Attending? *

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

Are you a member of the Church of Christ? *

Which congregation are you part of? *

Which congregation did you attend Camp with? *

Medical Illnesses *

Please include any and all conditions you may have.

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) *

Please include their name, email and telephone number(s) so we can effectively contact them in any event.

Parent/Guardian's name *

Relationship to Camper *

Parent/Guardian's Phone Number *

Please include a contact number so that we can effectively reach you.

Parent/Guardian's Email *

Please include your email for any updates regarding the Retreat.