• Camp Weed Fundraiser High School Youth Lock-In

    December 11-12, 2026 at St. Peter's Episcopal Church - 801 Atlantic Avenue Fernandina Beach, FL 32034.
    • Youth Participant Information 
    • Medical Information 
    • Permitted to take over-the-counter Pain & Cold Medicines
    • Primary Contact Information 
    • Format: (000) 000-0000.
    • Format: (000) 000-0000.
    • Liability Information 

    • CONSENT FOR MEDICAL TREATMENT | As the parent or legal guardian of the above-named participant, I hereby give my consent for emergency medical care prescribed by a duly licensed Doctor. This care may be given under whatever conditions are necessary to preserve the life, limb, or well-being of my dependent.

    • Consent to the use of any video images, photographs, audio recordings, or any other visual or audio that taken of the child of the undersigned during the activity/event to be used, distributed, or as the Confirmation Retreat Leaders sees fit. Initial*
    • Signature & Payment 

    • By signing and submitting this registraiton form, you understand and agree to all policies.

      Once you click "Register" you will be redirected to pay the registration fee. You may use your credit/debit card or PayPal account to pay the fee.

    • Check Out

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        Registration Fee

        Includes breakfast, and lunch on Saturday and a Diocese of Florida T-shirt

        $40.00$40.00
          
        Total
        $0.00$0.00

        Credit Card
      • Today's Date*
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        2 digit month, 2 digit day, 4 digit year
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