2023 Sr. High Winter Retreat Registration

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January 13 - 15, 2023

For those currently enrolled in grades 9 - 12

Email *

CAMPER'S Full Name *

CAMPER'S Gender *

Male

Female

Non-Binary

CAMPER'S Year in School *

9th Grade

10th Grade

11th Grade

12th Grade

CAMPER'S Street Address *

CAMPER'S City *

CAMPER'S State
*

CAMPER'S Zip Code
*

CAMPER'S Date of Birth *

YYYY

Does the camper have a roommate request? This person must also request this camper as a roommate.

PARENT or GUARDIAN 1 -- Full Name *

PARENT or GUARDIAN 1 -- Cell Phone Number *

PARENT or GUARDIAN 1 -- Email Address *

PARENT or GUARDIAN 1 -- Street Address
*

PARENT or GUARDIAN 1 -- City
*

PARENT or GUARDIAN 1 -- State
*

PARENT or GUARDIAN 1 -- Zip Code
*

PARENT or GUARDIAN 2 -- Full Name
*

PARENT or GUARDIAN 2 -- Cell Phone Number
*

PARENT or GUARDIAN 2 -- Email Address
*

PARENT or GUARDIAN 2 -- Street Address
*

PARENT or GUARDIAN 2 -- City
*

PARENT or GUARDIAN 2 -- State
*

PARENT or GUARDIAN 2 -- Zip Code
*

Emergency Contact *

Please list all parties who should be contacted in case of an emergency while the above-named camper is attending Sr. High Winter Retreat at Camp Hope from January 13 - 15, 2023. Please include full names and phone numbers.

Name and phone number or email for person responsible for payment. *

A deposit of $30 is required to hold your reservation. You may pay that by credit card through this form -- a 5% handling fee will be added. *

Pay $30.00 deposit by credit card (a 5% handling fee will be added)

Pay $30.00 deposit by check. Please make check payable to "Camp Hope" and mail to 15 Ridgeway Avenue, Blairstown, NJ 07825.

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