We are having a special for the retreats! Bring 3 paying campers and the 4th camper comes free! You must pre-register at least one week before the camp you are planning to attend.

Register for a Camp or Retreat

To register for Camp--Copy and paste this form to an email

Fall Retreats 2009 

Registration

_____ Junior Retreat (8-13 yr olds) April 23-24 Speaker:

_____ Teen Retreat (12-18 yr olds) April 9-10 Speaker:

Cost: Retreat cost is $20

Please pre-register by phone (276) 964-2230, mail, or email campevan@live.com

Name_____________________________________________________   Birthdate __________________

Address___________________________________________________            Boy _____  Girl _______

City_______________________________________________________

State___________   Zip_______________________

For campers under 18 years of age

Guardian: _____________________________________________________________

Phone Numbers: _______________________________________________________

Medications: ___________________________________________________________

Allergies: _______________________________________________________________

Insurance: _______________________________________________________________

Policy & Group Number: ___________________________________________________________

Insurance Phone: _____________________________________________________

In an emergency, I give permission for medical treatment to above child by authorized personnel. I absolve the camp of any liability beyond that of due care and sound judgment.

Parent or Guardian:__________________________________________________________