Spring Retreat

Elementary Spring Retreat March 26-28
Grades 3-6 6PM-1:30PM $45
*Registrations received after March 12th will incur a $10 late fee*
(No dinner Friday night - Snack will be served)

There are three ways to register for this retreat.
1. Fill out the online registration form and pay by paypal. All online registrations must be paid online or they will be deleted. There is a $1.50 processing fee for online payment for the retreat.
2. Call us at 910-628-6326 or e-mail us for other registration information.
3. Download the following form and send it in to :Camp Grace/ 145 Grace Dr./ Fairmont, NC 28340. To download the registration form,

Online Registration Form:

Camper’s Name:


	Is Called:


	Age:


	Current Grade:


Birthdate:


	Race:


	Gender:

Mailing address:


	City:


	State:


	Zip Code:


	Home Phone:

Parents or Guardians:

Work Phone:

How did you hear about Camp Grace?


	Cell Phone:

Do you attend church?


	Name of Church:

Cabin mate request:

* You may only request one friend. Your friend must also request you.

List two people who are authorized to pick up your child if you are unable to come. *Photo ID may be required.


	Medical Information

Does the camper have medical insurance?


	Height:


	Weight:

Insurance Company:

Policy Number:


	Date of last tetanus (or DTP):

*Camp insurance does not cover any pre-existing medical condition. In case of accident or injury, camp insurance will be filed as secondary to your insurance.

List any known allergies and type of reaction.


	List any medical problem, disability, or reoccurring illness.

Are there any specific activities limited by a physician’s advice?


	Name and Phone Number of Family Doctor.


	Is there anything else you think we should know?


	Please list the medications your child will be bringing to camp. Please include dosage, time of day to be given, and reason for taking.

*All medications, including over-the-counter and prescription, must be turned in to the camp nurse at registration. Bring current medication in its original container with instructions. Asthma inhalers are allowed in the cabin upon approval from the camp nurse.

By clicking submit below you agree to the following:
-I agree to have my child’s immunizations current prior to entering camp.
-I give my child permission to complete in the entire camp program unless otherwise noted on the medical form.
-I understand that if my child misbehaves or brings unacceptable items he/she will be sent home without a refund.

Medical Release and Waiver: The information given above is correct as far as I know. I understand that there are risks involved in camp and I accept this risk as a part of my child’s participation. I further agree to indemnify, hold harmless, and defend Camp Grace, its board members, executive officers, staff, and employees from any and all claims for injuries, damages, or loss sustained by me or my child arising out of, connected with, or in any way associated with Camp Grace. Emergency Authorization: I hereby give permission to the first aid personnel selected by the camp director to provide standard first aid care and administer over-the counter medication, and in the event that I cannot be reached in an emergency, I hereby give permission to the physician selected by the camp director to order X-rays, routine tests, hospitalize, secure proper treatment for and to order injection and/or surgery for my child as named above. Promotional Release: I hereby give permission for the use of photos/videos in which my child may appear in any promotional materials.


	[Spring Retreat]