Winter Blast Family Retreat Registration Form with Payment

Winter Blast Family Retreat

Please register for your retreat by filling the form below.
Full Name*

First NameLast Name
E-mail*
example@example.com
Phone Number*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Church you most often attend
Church Name
Any food allergies?
List all allergies for our Food Service.
Is there any information you would like us to know?
ie. wheel chair ramp needed, service dog, etc.
How did you hear about White Mountain Camps?
ie. social media, church, friend, etc.
First Time Attending?

YESNO
List all family participants attending this event in which you will sign the Waiver of Liability on their behalf.*
First and Last Name
Signature*

Clear
Payments are processed through Square. We will accept major credit and debit cards.

Begining October 25, 2025 there will be a 3% fee for credit/debit card charges on all purchases.
Options for payment*

I will pay with a credit card nowI will pay upon arrivalI will pay over the phoneI will send a checkOther
Retreat Costs/Housing Choice

Saturday Only ($100.00 up to 4 family members)Retreat Only No Housing ($200 up to 4 family members)Retreat w/ Cottage Housing ($350 up to 4 family members)Retreat w/ Lodge Housing ($350 up to 4 family members)Additional family members ($50 per)

Retreat Costs/Housing Choice

Saturday Only

$100.00

Retreat Only No Housing

$200.00

Retreat w/ Cottage Housing PreferredUp to four members of your family

$350.00

Retreat w/ Lodge Housing PreferredUp to four members of your family

$350.00

Additional Family Members

$50.00 Quantity

Subtotal

$0.00

Tax

$0.00

Total

$0.00