Youth Retreat Registration Forms

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This form must be completed by the parent or guardian of the camper. Please complete one form for each camper.

April 14 -16, 2023 We will start at 8pm on Friday and end around 10am on Sunday morning.

Cost: $115, send check to Merom Camp and Retreat Center, 8555 Phillip Street

Merom, IN 47861, or pay through Pay Pal, Venmo (please note Spring Connection and Name)

Email *

Registration Type *

Youth

Adult Chaperone

Retreat Director

Who is filling out this form on behalf of the camper? *

Parent

Legal Guardian

Self - Adult Chaperone

Camper's Legal Name *

Camper's Preferred Name

Camper's Birthday *

YYYY

Camper's Sex *

Male

Female

Camper's Gender Identity

Male

Female

Non-Binary

Other:

Clear selection

Camper's pronouns

she/her

he/him

they/them

Other:

Clear selection

Camper's Mailing Address *

Camper's Email Address

Camper's grade level this fall: *

Please list any dietary needs/restrictions or food allergies here:

Camper's T-shirt Size *

Home Church and City, State (if applicable)

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