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Youth Retreat Registration
Community of Christ
Camp Bountiful Retreat Registration Form
Check all that Apply
( ) Senior High Retreat ( ) Junior High Retreat
( ) Camper
Name:________________________________Age:_______
Grade Completed:_______
Address:________________________________________
City:______________________State:_____Zip:________
Phone:______________
Email:__________________________________________
DOB:___________________
Congregation: ____________________________________
MissionCenter: ___________________________________
I promise to live by the camp rules and to actively support the programs developed by the camping staff.
Camper Signature:____________________________________
I give my permission for ___________________________to attend Junior/Senior High Weekend Retreat. I have confidence that those in charge will exercise
diligence for the safety of my child. I hereby release the leaders of any responsibility for personal injury.
In case of a medical emergency, I understand that every effort will be made to contact the
parents/guardians of the camper. In the event that I cannot be reached, I hereby give my permission to the physician selected by the camp director to hospitalize, secure proper treatment for, and order injections,
anesthesia, surgery, or other medical procedures for my child as named above.
Emergency Notification Information:
Name:__________________________________________
Relationship:______________
Address:_________________________________________
City:___________________State:________Zip:_________
Phone:______________
Signature of parent/guradian:
_____________________________________________
Date: ____________________________________
(Parent/Guardian must sign and date form for registration to be complete.)
Call in, e-mail or mail your registration to the business manager
at least one week prior to the retreat. The website is down so please email or call the registrar if you are coming.
Registration fee is $50 (subject to change)
MAKE CHECKS PAYABLE TO CAMP BOUNTIFUL Updated March 5, 2010 |
