Retreat 2024 Registration
Please fill in the form below and bring all payments with you on the weekend. Any cancellations must be forwarded to Andy (andy@simplechurches.ca) by Friday, November 3.  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.)
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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
Street Address *
City *
Postal Code *
E-mail *
Local Phone Number *
Total Number of Adults @ $100 Each (actual cost is $190) *
Total Number of Teenagers 13-17 @ $75 (actual cost is $190)
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Total Number of Children age 4-12 @ $40 (actual cost is $80)
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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.
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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?
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Are you in need of a ride? If so, for how many?
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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? *
Any constructive suggestions for this years retreat?  
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