Participant's Name *

First Name

Last Name

Birthday *

MM

DD

YYYY

Gender *

Male

Female

Other

Parent/Guardian's Name

First Name

Last Name

Photo Permissions *

Every camp experience includes a group photograph which is given to all participants, used in a camp display, and posted on our website. Do you give permission for individual and small group pictures of your youth or child to be taken and posted on our website or used in publicity brochures and posters for future camps? If a choice is not marked, it will be assumed that your child’s photo CAN be used for publicity.

Yes

No

Parent/Guardian Number *

(###)

###

####

Emergency Contact Number *

(###)

###

####

Retreat Covenant *

• I will participate in the retreat expecting to grow in my faith and relationship with others, becoming a special part of the camp community. To do this, I covenant to follow all the rules and guidelines set by the Christian Church in Alabama Northwest Florida and any others set for this event. With this, I commit myself to the following: To be on time, attend and be attentive for all activities and participate in them fully • Have fun and make sure everyone else has a great time • To respect each other regardless of age and to respect others’ feelings and thoughts • I will not go from adult to adult until I get the answer I want • Be myself and open to making new friends • Be inclusive at all times • Cooperate with the counselors, keynoter, director and other staff members at all times • Be respectful of God’s beauty in this special place and only leave footprints behind • To take all that I learn about God and share it with my friends, family and church I also agree to follow all camp policies as listed below: Summer Camping Program Policies • Participants are expected to remain for the entire event. No one should expect to arrive late or leave early without prior permission from director. The only visitors will be those invited before camp by the director. • No one, including counselors, will leave the camp without special arrangements with the director. • All cars will be parked for the duration of the event. Keys will remain in possession of the director. • Events for youth in Alabama-Northwest Florida are “smoke free.” • Possession or use of intoxicating beverages, drugs or marijuana is prohibited. Violators will be sent home. • Stewardship of retreat property is important. Cottages must be left in as good or better shape than it was found upon arrival. Repair of property damage will be paid by the person(s) responsible. • Food must be kept out of the sleeping areas. If you have special foods, arrangements can be made with director. • Bedrooms are off limits to members of the opposite sex. • Offensive, insensitive and foul language is not acceptable.

Yes, the camper agrees to this covenant

Yes, the guardian agrees to this covenant

Do you have any health problems?

Yes

No

Are you currently under the care of a physician or psychologist? *

Yes

No

Do you expect to have any difficulty with normal event activities? *

Yes

No

Do you have any food or other allergies?

Yes

No

Do you take any prescription medication? *

Yes

No

Fees *

$225.00

$275.00 ($50 to donate toward missions projects)

$325.00 ($100 to donate toward missions projects)

Add $35 for late registration

Payment Method *

Payment Arrangements

I am paying full amount by check. I will mail to the Regional Office by the registration deadline.

I am paying full amount online.

I am paying partial amount online. My congregation will send the remainder on my behalf.

My church is paying full amount on my behalf.