Please complete all the Questions below
Please turn in Release Form and Payment to your Youth Leader upon registering online. Check with your youth leader for the price. The regular signup deadline is February 1. Late Registration is from February 1-15 and the price goes up by $25.
Church Name *
if your church is not listed please email claire.cantrellpaulson@gmail.com to have it added
First Name *
Your answer
Last Name *
Your answer
Name for Name Tag *
Your answer
Home Address Line 1 *
Your answer
Home Address Line 2
Your answer
City *
Your answer
State *
Your answer
Zip *
Your answer
Grade or Adult *
Date of Birth *
MM
/
DD
/
YYYY
Gender (for cabin assignments) *
Participant Email Address *
Your answer
Tshirt Size *
Parent/Guardian Name *
First and Last Name
Your answer
Parent/Guardian Phone Number *
Your answer
Parent/Guardian Email *
Your answer
Relationship to Participant *
Your answer
Emergency Contact Name *
First and Last Name - This is to be someone not listed as the Parent or Guardian and not on the trip
Your answer
Emergency Contact Phone Number *
Your answer
Emergency Contact Relationship to Participant *
Your answer
Allergies and Food Needs
Please list all Allergies (both Food and other) and any food needs that are needed for the participant
Your answer
Mid Winter Code of Conduct
I promise to:

- Complete all required forms and turn them in to my youth leader.
- Report all medications and turn them in (labeled and with instructions) to my youth leader.
- Not have in my possession or use fireworks, firearms, illegal drugs or alcohol.
- Stay in appropriate sleeping areas (i.e. boys in boys’ area, girls in girls’ area).
- Respect my peers by refraining from using foul or abusive language.
- Bullying will not be tolerated.
- Respect my peers by refraining from fighting, wrestling, or rough horseplay.
- Respect my leaders by cleaning up as directed.
- Participate in all retreat activities.
- Be present where I am supposed to be at time that I am supposed to be there.
- Report to my leader if I see someone hurting themselves or others.

Please type your first and last name to acknowledge this agreement and will abide by the code of conduct *
Your answer
Release Forms
This form will need to be downloaded and turned into the Youth Leader to attend the retreat if you are unable to download and print please contact your Youth Leader for a copy of the form
https://www.stoneycreekranch.org/_files/camper-indemnity.pdf
Release of Liability
I, the undersigned, do hereby verify that the above information is correct and I do hereby release and forever discharge all sponsors and the Capital District UMC from any and all claims, demands, actions or causes of action, past, present, or future arising out of any damage or injury while participating in 2019 Youth Midwinter at Stoney Creek Ranch
Please type your first and last name to acknowledge this Release of Liability *
Your answer
Back Ground Check and Child Protection Training
Adult Background Checks: All adults who attend must complete the TRUSTed con Confianza certification prior to arrival. Churches will be expected to turn in proof of approval for all adults attending with their group. https://riotexas.org/safesteps
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