JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
2023 Youth Retreat Application
Camp Dates: April 14-16, 2023
Camp Location: Kellogg Springs Camp
Camp Address: 1111 Kellogg Camp Ln, Oakland, OR 97462
Camp Cost: $140.00 per Participant
Camp Director: Randal Lee - (541)210-0531 -
lee.randal@gmail.com
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
I am registering a
*
Camper (Grade 8-College)
Staff (25+)
I acknowledge that the event registration cost is $140.00 per applicant, with payment due to your local church prior to event.
*
Yes
Applicant's Name (one application per person):
*
First and last name
Your answer
Applicant's Age:
*
Your answer
Applicant's Grade (write N/A if staff):
*
Your answer
Applicant's Sex
*
Female
Male
Adult/Parent/Guardian Name:
*
By typing my name, I hereby give permission for my child to attend the April 14-16, 2023 youth retreat at Kellogg Springs Camp
Your answer
Adult/Parent/Guardian's Email:
*
Your answer
Adult/Parent/Guardian's Primary Telephone Number:
*
Your answer
Adult/Parent/Guardian's Home Address:
*
Your answer
City, State, and Zip:
*
Your answer
I acknowledge that parent/guardian authorization for underage applicants is required and will be verified with an Agreement to Participate via follow-up email.
*
Yes
In What City Is Your Branch Church Located?
*
Your answer
What is Your Pastor's Name?
*
Your answer
Next
Page 1 of 8
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms