Retreat 2025 Registration
Please fill in the form below to register for the retreat. Any cancellations must be forwarded to Andy (andy@simplechurches.ca) by October 31st.  Unfortunately, failing to do so may result in you still being charged. (It's the camp's rules to ensure that they do not have to absorb the costs of food, etc.)
Sign in to Google to save your progress. Learn more
Last Name *
First Name(s) *
If married, include both names here.
First Child's Name
First Child's Age
Second Child's Name
Second Child's Age
Third Child's Name
Third Child's Age
Fourth Child's Name
Hello!
Fourth Child's Age
Where do you live? *
E-mail *
Local Phone Number *
Total Number of Adults @ $110 Each (actual cost is $190) *
Total Number of Teenagers 13-17 @ $85 (actual cost is $190)
Clear selection
Total Number of Children age 4-12 @ $50 (actual cost is $80)
Clear selection
Total Number of Children age 0-3 @ $0
No cost for children in this age range, but we still need to include them in our group count.
Clear selection
Total Amount Owing *
Please include the total of your registration below.
Are you in need of additional financial assistance?
Are you capable of providing a little extra for subsidy support?  If so, please indicate how much.
Do you have space in your car for any other guests to travel with you?
Clear selection
Are you in need of a ride? If so, for how many?
Clear selection
In the event of an emergency, I agree to absolve simplechurches and its leadership of any liability.  I also agree and give consent for them to contact emergency services on my behalf if they deem it to be in the best interest of myself and/or my family. *
Required
Emergency Contact Name *
In case of emergency, we may need to contact someone on your behalf.
Emergency Contact Phone Number *
Any allergies we should know about? *
Submit
Clear form
Never submit passwords through Google Forms.
GoogleForms
This content is neither created nor endorsed by Google.