Family Camp Out 2020
Riverside Camp and Retreat Center
Email address *
Event Dates: January 17-19, 2020
Event Cost: $50 per person
Family Member #1 (First and Last name) *
Your answer
Family Member #1 Phone Number *
Your answer
Family Member #1 Address *
Your answer
Family member #1 Age *
Family member #1 Gender *
Family Member #2 (First and Last name) *
Your answer
Family Member #2 Phone Number *
Family Member #2 Address *
Family member #2 Age *
Family member #2 Gender *
Family Member #3 (First and Last name)
Your answer
Family Member #3 Phone Number
Family Member #3 Address
Family member #3 Age
Family member #3 Gender
Family Member #4 (First and Last name)
Your answer
Family member #4 Age
Family member #4 Gender
Family Member #5 (First and Last name)
Your answer
Family member #5 Age
Family member #5 Gender
Please list any additional family members and their ages that are participating in the Family Camp Out weekend.
Your answer
Emergency Contact Name (A person not attending the Family Camp Out) *
Your answer
Emergency Contact Relation (Mother, Father, Friend) *
Your answer
Emergency Contact Phone Number *
Your answer
Church Home
Your answer
Dietary restrictions *
Required
Please provide the names of the family members with their dietary restriction.
Your answer
After completing this form, credit card payments can be taken over the phone, or checks can be sent to Riverside Camp and Retreat Center 7305 County Road 78 LaBelle, FL 33935
I understand that my registration is not complete until full payment is received. *
Required
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