PAC - NW Camp Registration
Dates: July 30th 5:00 pm - Aug 3rd 9:00 am
Location: Shoshone Mountain Retreat, 29216 Coeur d’Alene River Road, Wallace, ID
Contact: Tamar Pfeiffer, tamar.pfeiffer@gmail.com, (509)703-5307 (call or text)
Nathan Pfeiffer, revpfei@gmail.com, (509) 703-2157 (call or text)

Email address *
Names of Participants *
Your answer
Ages of Participants
under 5
5 - 9
10 - 18
over 18
Participant 1
Participant 2
Participant 3
Participant 4
Participant 5
Participant 6
Address *
Your answer
E-mail address *
Your answer
Home/Cell Phone *
Your answer
Work Phone
Your answer
Home Congregation *
Your answer
Parents/Gaurdians Names (if not attending)
Your answer
Optional Activities for Youth and Families (Choose your favorite activity. We will do the most popular choice.) This activity is included in the youth camper fees. The cost of the activity for families is $7.50 per youth (ages 10 - 17) and $15 per adult.
Zip Line
Archery
Rock Climbing
Participant 1
Participant 2
Participant 3
Participant 4
Participant 5
Participant 6
Optional activities for Families ($5 per activity) These activities are included in the $100 fee for youth campers
Silver Mine Tour
Tubing down the river
Family member 1
Family member 2
Family member 3
Family member 4
Family member 5
Family member 6
Kids 3rd grade and below must share a tube with an adult. (No extra cost) Also please bring a life jacket for kids 3rd grade and below as the provided life jackets will not fit.
Fees for Youth Campers cover all camping, meals, and activities for the week.
$100 per camper (payable by the first day of camp)
Family fees cover all camping, four breakfasts, one dinner, and the activities the family wishes to participate in.
Contact Tamar (tamar.pfeiffer@gmail.com or 509-703-5307) for your fees based on the number and ages of the people in your family and the activities in which you wish to participate.
Medical conditions we should be aware of
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Allergies
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Prescribed or over-the-counter medications
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Current Tetanus Immunization?
Name of Health Insurance Plan
Your answer
Policy or Group Number
Your answer
Physician's name and phone number
Your answer
Please list any other information that would be necessary to initiate medical treatment.
Your answer
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