Spring Retreat Registration

Costs

Older Youth --- $45
Senior High --- $45
Junior High --- $45
Junior --- $40

Registration

Retreat *

Older Youth (College-Age)

Senior High (10th through 12th grade)

Junior High (7th through 9th grade)

Junior (4th through 6th grade)

Camper's Name *

Your answer

Street Address *

Your answer

City, State, Zipcode *

Your answer

Phone Number *

Your answer

Email *

Your answer

Grade *

Birthday *

YYYY

Gender *

Male

Female

Parent/Guardian Name *

Your answer

Parent/Guardian Phone Number *

Your answer

Payment Method *

Pay Online (bottom of page)

Pay in Person

Congregation Paying

Other:

If "Other" or "Congregation Paying" please explain

Your answer

(To pay online, please return to retreat information page and scroll to bottom)

Retreat Guidelines

Participation
Because we’re at retreat to learn more about our relationship with our Heavenly Father, it will
also be important to grow in our relationship with each other by participating in all retreat
activities. It is also to be expected that each camper will be helping with cleaning up and
other chores that may be necessary.

Off limits!
- No boys in girls’ cabin areas and no girls in boys’ cabin areas.
- Kitchen food supply areas are also restricted.
- Additional restricted areas may be determined by the directors.

Dating relationships
We’d rather you use this time to build up your relationship with God instead of building a
romantic pursuit. Stay public and take a break from hand holding, hugging, kissing, etc.

Electronic Devices
Because we’re taking time out from the usual activities that might distract us, please leave at
home any items such as cell phones, MP3 players, radios, portable game systems, etc.

Substances
Items such as tobacco, alcohol and drugs are prohibited, as campers should be receiving a
spiritual high that will surpass any man-made chemical.

Medications
Please turn in a list of any and all medications (prescription and over the counter) that the camper
will be needing during the time at camp, and the nurse will make sure campers receive them
at the appropriate times. Exceptions can be made for emergency medicine such as asthma medications, so please discuss any concerns with the nurse.

Visitors/Leaving Retreat/Phone calls
- No one will leave retreat without permission of the director. Campers who leave without permission forfeit their right to
return to the retreat.
- Visitors are not allowed during the retreat.
- Campers may make emergency phone calls by provision of the director.

Dress Respectfully
- Footwear needs to be worn at all times
- Shirts on during recreation
- Because we would like to cover rather than expose, please, no tube tops, spaghetti straps or halter tops
- Please, no clothing with logos conveying a drug, alcohol, or anti-Christian themes

Camper Agreement *

I have read and agree to follow retreat guidlines

Required

Parent/Guardian Permission *

I approve my child's participation in the CMRB retreat and give permission to the directors to make decisions regarding the physical well-being of my child. I have read the guidelines and will support the directors in upholding those guidelines for the good of the retreat. I give my permission to a physician &/or hospital to provide proper medical treatment if necessary, and will assume liability for resulting expenses.

Required

Emergency Contact Name *

In case the parent/guardian can't be reached, please provide an additional contact in case of emergency

Your answer

Emergency Contact Phone Number *

Your answer

Emergency Contact Relationship *

Your answer

Medical Information

Insurance Company

Your answer

Policy Number

Your answer

Allergies

Your answer

Last Tetanus Shot

Your answer

Medications

Your answer

Special Instructions

Your answer

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