Fall Retreat – Praise Community Church

Register for Fall Retreat 2022

Attendee Name*
First Last
Phone*
Address*
Street Address City State ZIP Code
Birthday*
Gender*
T-Shirt Sizes*
Parent/ Guardian Name*
First Last
Parent/ Guardian Email*
Parent/ Guardian Phone*
Attendee Insurance Information:*
Medical / Allergy Information Insurance Company Insurance Policy No Insurance Preauthorization Required YES or NO
Media Release*
I give permission and consent to allow photographs or videos to be taken of my child/camper during the camp. I further understand that the use of any such photographs or videos may be used on social media sites promoting or reporting on the camp.
- Yes
- No
CAPTCHA

Medical / Allergy Information	Insurance Company	Insurance Policy No	Insurance Preauthorization Required YES or NO