Winter Retreat 2027

This form is to gather basic information for our Winter Retreat in Servierville, TN. Completion of this form and a $50 nonrefundable deposit secures a spot for your student (online payments have an additional processing fee). All parents/guardians will need to complete a "Consent to Travel" and "Medical Consent and Release" form before leaving. All payments for camp are due by end of December 27, 2026. Please discuss any special circumstances with Josh Taylor (Call/text 931-409-9490). There will be a parent meeting on January 10th following morning worship service detailing the weekend. All are encouraged to attend.

Student First and Last Name

Parent/Guardian First and Last Name

Parent/Guardian Email

This address will receive a confirmation email

Parent/ Guardian Phone

Payment (online payments include a processing fee)

Secondary Emergency Contact Name

Secondary Emergency Contact Phone Number

Sweatshirt Size

Has your student placed his/her faith in Christ

Yes No I'm not sure

Any special needs or dietary restrictions? Please list below or leave blank

Any specific prayer requests for your student leading up to winter retreat?

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Winter Retreat 2027

Description

Please Fix the Following