Marriage Retreat

Spouse 1 Name

First NameLast Name

Spouse 2 Name

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone:

Email Address:

Home Church:

Please list any allergies or dietary restrictions

Other important medical history you want to share

Emergency Contact (not your spouse) and number

I understand that participation in the marriage retreat and its activities is voluntary. I agree to follow all safety guidelines and procedures of Southern Illinois Chrisitian Service Camp and accept responsibility for my own safety and belongings.

Photo Release

I hereby give permission to Southern Illinois Christian Service Camp to use photographs of myself taken by the official or volunteer staff to be used for related camp activities, programs or promotion including the web site of SICSC. I also recognize the these photographs are property of SICSC.

Code of Ethics

1. Campers failing to respond to the authority of the camp staff will be sent home.

2. Campers who fail to abide with the camp schedule (exceptions: sickness, etc.) will be sent home

3. Campers caught stealing or pilfering through others belongings will be sent home.

4. Unacceptable behavior will not be tolerated. Any act deemed unacceptable by SICSC staff, Camp Dean or faculty will result in dsimissal.

5. Campers who destroy camp proprerty will be responsible for the cost of repair or replacement.

6. Any camper caught with alcohol, tobacco, vape, drugs or weapons will be dismissed.

7. Campers are expected to treat others in a Christian manner.

8. Report all illness or injury to the camp nurse immediately.

9. Modest attire will be worn at all times.

10. I will not bring anything on the do not bring list.

I have read and understand the guidelines listed above and agree to follow them.

Spouse 1 Signature

Date:

Spouse 2 Signature

Date:

Enter Balance Due amount into PayPal Total field below then click Credit Card or PayPal Checkout. Venmo Checkout is under PayPal.

Hit submit to bypass payment.

COST IS $80

Paypal Total

USDDescription

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.

SICSC Marriage Retreat 2026

Paypal Total

Payment Methods