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Office - (903) 872-3664
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Fall Retreat 2023
Leader Registration
Take Me Back
Leader Information
Leader First Name
Gender
Address
Leader Last Name
Date of Birth
Mobile Number
Church Information
Which church do you attend?
Medical Information and Waiver
Emergency Contact
Insurance Provider
Insurance Policy No
Insurance Subscriber Name
Emergency Contact Phone
Insurance Phone No
Insurance Group No
Insurance Subscriber DOB
Allergies
List all food allergies
List all environmental allergies
List all medical allergies
Medications
List all medications
List all physical activities that your student cannot participate in
I understand all medications must be turned in to medical staff
Waivers and Releases
Camp Rules
Paintball Release
Waiver and Release
Photo Use Agreement
I have received the following documents and I agree to all terms & conditions:
Camp Rules
Camp Waiver and Release
Paintball Release
Photo Use Agreement
Add your options to the cart
Registration
Leader Registration $75
Concessions Tab
Concessions Tab $25
Concessions Tab $50
Concessions Tab $75
I understand that registration will not be refunded after October 31, 2023. NO EXCEPTIONS. This policy is not for paintball & concessions.
I agree to receive SMS text updates regarding retreat. Standard text rates may apply.
I understand that no refund will be given for shirts after shirt orders are placed
I understand my shirt must be prepaid to be ordered
Leader's Signature
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Submit Registration
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