2019 Winter Retreat - Camper Registration
January 3-6, 2019 (Thursday - Sunday)
Hosted by the Southwest church of Christ
Cost: $30 per camper (includes long-sleeve T-shirt)

In addition to this online registration, you must also print out & fill out the Release Form located on this website, and mail in with your payment.

First Name *
Your answer
Last Name
Your answer
Current Grade
Your answer
The $30 registration fee includes a long-sleeve T-shirt. Please select your T-shirt size:
Address (Street, City, State, Zip)
Your answer
Full Name of Home Congregation
Your answer
Year of baptism
Your answer
Emergency Contact Information
Name of Parent or Guardian
Your answer
Phone Number
Your answer
Email Address
Your answer
Please fill out and sign the health record for each camper.
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