Chambers Chill Registration Form
Registration form required for Weekend of March 6-8, 2020
Registration is on March 6th Starting at 6:30
Early Bird price is $110.00 before Jan.1st.
After January 1st the price is $120.00
Sunday, March 8th family dinner and closing program is at 12:30 with departure after.
Email address *
Child's Last Name *
Child's First Name
Date Of Birth *
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Gender *
Grade *
Home Address *
Guardian or Parents Last Name *
Guardian or Parents First Name
Emergency Contact Number *
Church Affiliation
Roomate Requests
Chill Camp dates March 6-8, 2020
Pricing is $110.00 if postmarked by ,January 1, 2020, $120.00 if received after.
This camp is for children grades 3- 8th grade.
Make Checks payable to: Chambers Camp and Retreat
Send checks to: Chill Camp Registrar Kimberly Ouderkirk
114 Campground Road, Beaver Dams, NY 14812


Family dinner on Sunday at 12:30 is included in the registration cost for the parents of the registered child. Additional family members are more than welcome to attend at an added cost of $5.00 per person. Please provide the total number of people attending family dinner in your party. *
Please list any allergies your child may have:
What to bring:
Every child needs to bring a sleeping bag or bedding, pillow, toiletries, Bible, flash light, winter outer clothing( snow pants, coat, hats, mittens, boots, and extra socks) to play outside in the snow. If you would like to bring a sled or snow tube with you for outside play it is encouraged.
Conduct and Dress Code
*Campers are expected to treat everyone and their property with respect and consideration
* Campers will demonstrate Christian values in language, behavior, and dress.
* There is a zero tolerance policy regarding public displays of affection, sexual contact, alcohol, tobacco, illicit drugs, weapons, gambling, and pranks.
*Modesty in dress is expected. All clothing will cover the abdomen and all under clothing.
* No clothing that references tobacco, alcohol, drugs, immoral behavior or rude comments, including related insignia's or advertisements are permitted.
* Campers and their parents/guardians will be financially responsible for any and all property damage directly resulting from inappropriate behavior.
* Everyone will be open to the incredible things God has in store for this weekend! The lasting effects of what is learned at camp are life changing.
Registration and Pick up Information
Registration is 6:00-7:15 PM on Friday, March 6th . Pick-up is after family dinner/closing program Sunday, March 8, 2020.
Parent and Guardian Permissions
* I hereby agree to allow my son/daughter to attend Chambers Chill Camp and participate in all activities other than medically necessary exceptions. *
Required
* I understand and agree to all rules regarding conduct and that inappropriate behavior may require my child's immediate removal from the grounds. *
Required
* I grant Chambers Camp and Retreat Center the right to take, print, and/or electronically use photographs/videos of me and/or my child in connection with camp activities for such lawful purposes as publicity, illustration, advertising and web content. *
By Checking the designated box I am signing that I will adhere to all policies and regulations set forth in this Chill Camp registration form. *
Required
A copy of your responses will be emailed to the address you provided.
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