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SEASONS REGISTRATION
Begin your registration process for our upcoming Seasons Ladies Retreat here. Once submitted you will receive an email indicating your registration is complete.
Email
*
example@example.com
Name
*
First Name
Last Name
Start Date of Event
*
/
Month
/
Day
Year
Date
End Date of Event
*
/
Month
/
Day
Year
Date
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Format: (000) 000-0000.
T-Shirt Size
*
Please Select
Child Small
Child Medium
Child Large
Adult Small
Adult Medium
Adult Large
Adult X Large
Adult XX Large
Adult XXX Large
Name of Group
*
What is the name of church, organization, or school group with whom you are coming?
Housing
List your roommate or church group preference
Any Food Allergies?
*
Yes
No
Food Allergies
*
Please list any food allergies you/your camper have.
Which Waiver Form do you need?
*
Adult (aged 21 or older)
Minor (aged 20 or younger)
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WAIVER
ADULT
Camp activities include strenuous outdoor activities and out of camp travel in camp vehicles. As with most activities in life, there is an inherent risk in participating in these activities. By signing below you are indicating that you understand the risk involved in camp activities and you are willing to participate in all activities. All activities are well-supervised, with an emphasis on safety.
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Emergency Contact
Emergency Contact
*
First Name
Last Name
Emergency Phone
*
Format: (000) 000-0000.
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Permission
Camp activities include strenuous outdoor activities and out of camp travel in camp vehicles. As with most activities there is an inherent risk in participating in these activities. IT IS MANDATORY THAT THIS FORM IS FILLED OUT, SIGNED, DATED, AND RETURNED BY YOU. YOU WILL NOT BE PERMITTED TO STAY AS OUR GUEST UNLESS WE HAVE RECEIVED THIS FORM. A copy of this form will be emailed to you upon completion.
Legal Name
*
First Name
Last Name
Signature
*
Date of Signature
*
-
Month
-
Day
Year
Date
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MEDICAL WAIVER
CAMPER
Camp activities include strenuous outdoor activities and out of camp travel in camp vehicles. As with most activities in life, there is an inherent risk in participating in these activities. By signing below you are indicating that you understand the risk involved in camp activities and you are willing to participate in all activities. All activities are well-supervised, with an emphasis on safety.
Contact Information
Camper Birthdate
*
-
Month
-
Day
Year
Date
Camper Age
*
Please Select
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Parent/Guardian Name
*
First Name
Last Name
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Camper Health Information
To be completed by Parent or Guardian
Is Camper Covered by Family Health or Medical Insurance?
*
Yes
No
Insurance Carrier, Plan Name or Medishare Name
*
Name of Insured
*
First Name
Last Name
Relationship to Camper
*
Insurance ID Number
*
Insurance Card
*
Browse Files
Drag and drop files here
Choose a file
Upload copy of both sides of insurance card
Cancel
of
Immunizations up to date?
*
Yes
No
If "No" please explain
Currently Taking Medications?
*
Yes
No
Medications Taking
Dosage
Describe the dosage and frequency of administration
Chronic or Recurring Illness or Medical Condition
Activity Restrictions?
*
Yes
No
Health or Medical Concerns
*
Please describe any other health or medical concerns.
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Emergency Contact 1
*
First Name
Last Name
Emergency Phone 1
*
Format: (000) 000-0000.
Emergency Contact 2
*
First Name
Last Name
Emergency Phone 2
*
Format: (000) 000-0000.
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Permission
Camp activities include strenuous outdoor activities and out of camp travel in camp vehicles. As with most activities there is an inherent risk in participating in these activities. IT IS MANDATORY THAT THIS FORM IS FILLED OUT, SIGNED, DATED, AND RETURNED BY YOU. GUESTS WILL NOT BE PERMITTED TO STAY UNLESS WE HAVE RECEIVED THIS FORM. A copy of this form will be emailed to you upon completion.
Parent/Legal Guardian Name 1
*
First Name
Last Name
Signature 1
*
Parent/Legal Guardian Name 2
*
First Name
Last Name
Signature 2
*
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Seasons Registration Payment
Name on Card
*
First Name
Last Name
Card Email
where you want your receipt mailed
Debit or Credit Card Method
*
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( X )
Seasons Commuter Rate
For guests needing only meals and sessions
$
90.00
Seasons Overnight Rate
For guests needing meals, sessions, and lodging
$
145.00
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
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Submit
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