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
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Email *
I am registering a *
I acknowledge that the event registration cost is $140.00 per applicant, with payment due to your local church prior to event. *
Applicant's Name (one application per person): *
First and last name
Applicant's Age: *
Applicant's Grade (write N/A if staff): *
Applicant's Sex *
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
Adult/Parent/Guardian's Email: *
Adult/Parent/Guardian's Primary Telephone Number: *
Adult/Parent/Guardian's Home Address: *
City, State, and Zip: *
I acknowledge that parent/guardian authorization for  underage applicants is required and will be verified with an Agreement to Participate via follow-up email.  *
In What City Is Your Branch Church Located? *
What is Your Pastor's Name? *
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