2019 Alpine Camp Mothers Retreat
Registration Form for the weekend of February 1-3, 2019. The fee is $275.00 for the weekend for each participant and is due in full with registration. This covers all programs, lodging and food. Cancellation/refund deadline is January 7, 2019.
First Name *
Your answer
Last Name *
Your answer
Maiden Name *
Your answer
Birth Date
MM/DD/YYYY
MM
/
DD
/
YYYY
Email Address *
Your answer
Cell Phone # *
###-###-#### (This format really helps with our data entry. Thank you!)
Your answer
Address *
Street Address or P.O. Box
Your answer
City *
Your answer
State *
Please use two letter abbreviation (i.e. AL, GA, LA)
Your answer
Zip Code *
Your answer
Are there any dietary or other medical conditions that will require special attention for the weekend? *
If yes, please explain what they are and how we can help.
Your answer
If dietary allergy, is there a risk of anaphylaxis?
If you have a gluten free or vegetarian diet, please specify below:
Arrival plans: *
Transportation plans:
Cabin Mate Requests:
Please choose people with whom you would like to share a cabin. If you do not know others attending, trust us to select a cabin for you with ladies you will enjoy getting to know throughout the weekend.
Your answer
MOTHER'S RETREAT TERMS AND CONDITIONS
I understand that the Mother's Retreat total fee is $275.00 for each person attending and is due in full with registration. Cancellation/refund deadline is January 6, 2019.

I grant permission for Alpine Camp to use my likeness on the Camp website and in other Camp promotions.

I understand it is the responsibility of the attendee to become familiar with all the activities and programs offered by Alpine Camp for Boys at the Mother's Retreat weekend. I understand that my participation in any activity is completely voluntary. I further recognize that there are hazards and dangers inherent in camp events and programs, and although Alpine Camp has taken measures to minimize the risk of injury to camp participants, it cannot guarantee that the participants, equipment, premises and/or activities will be free of hazards, accidents and/or injuries. I further recognize the importance of knowing and abiding by the camp's rules, regulations, and procedures for the safety of camp participants.

I also understand that unlike summer camp sessions, no medical personnel will be on-site for Mother's Retreat weekend. I agree that it is my responsibility to make all decisions regarding my health and welfare, including securing proper treatment for any injuries or medical emergencies. I understand that any incidental charges, including medical bills for any accident, illness, or medications will be my responsibility.

I agree that any dispute between Alpine Camp for Boys, its owners, officers, directors, employees, contractors, volunteers and me shall be governed by the substantive laws of the State of Alabama, and that any mediation or suit initiated for me shall occur or be filed in DeKalb County, Alabama.

Mother's Retreat Terms and Conditions Approval *
PAYMENT INFORMATION
If you have any questions, please call our office at 256-634-4404 or email Jennifer at summer@alpinecamp.com.
Payment Options *
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