Request edit access
Franklin Baptist Association 2025 Youth Retreat Registration
For youth entering 7th grade through entering 12th.

Deadline for camper registrations is August 10.

$10 Retreat fees should be submitted to sponsoring church by August 10.  

All blanks must be completed.   If question does not apply, or not needed, type “NA” or none in blank. 


Sign in to Google to save your progress. Learn more
Email *
Camper's First Name *
Camper's Last Name *
Birth Gender *
Date of Birth *
MM
/
DD
/
YYYY
Grade Completed *
Sponsoring  FBA Church Name *
If selected Other above, print church name here
Parent(s) /Guardian *
Parent(s)/Guardian Email Address
 *
Home Phone *
Cell Phone *
Street Address *
City *
State *
Zip *
Emergency Contact Name *
Relationship to Camper *
Emergency Contact Phone Number *
Alternate Emergency Contact Name *
Alternate Emergency Contact Phone Number *
Permission to Participate in the follow (Check all that apply)
 *
Required
Other restrictions : Please List
 *
Medical Information (To be supplied by Parent or Guardian)
Note: ALL MEDICINE must be in original container(s) with complete instructions and MUST be turned in to Camp Nurse during registration/check-in. DO NOT SEND Ibuprofen or Tylenol - these are provided. 
May Tylenol or Ibuprofen be given by the nurse on an "as needed basis? 
 *
Insurance Company
 *
Policy/ID#
 *
The child's physician which is to be notified
 *
City/Phone#
 *
List any special medical problems or allergies
PARENT'S CONSENT/WAIVER: please carefully read the following and sign below:
I, the undersigned parent(s) or guardian(s) of the above-mentioned minor child, have read and consent to the camp rules, and do hereby give consent for ANY emergency care deemed necessary by Franklin Baptist Association Camp leaders and/or the medical facility(ies) to which is taken. I/We further agree to release Franklin Baptist Association and its representatives from liability for any injury or mishap which may occur at camp, including any accident which may occur during transportation to or from camp. I/We also give consent for pictures and videos of registrant to be used for limited camp publicity.
PARENT OR GUARDIAN SIGNATURE:
 *
Digitally printed name is authorized
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Google Forms