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2019 Fall Family Retreat Registration

We are super excited that you have chosen to join us for the R[4] 2019 Fall Family Retreat! Please complete the form below to reserve a spot for your family. More information will be sent upon receipt of your registration.

FYI

Campers arrive at Camp Copass at 6:00pm on Friday, September 13, 2019. Welcome/Pizza Party upon arrival.

Families will be assigned to their own motel rooms. Rooms hold 4 adults comfortably. Extra accommodates (cots/cribs) can be added for small children. Each room has its own bathroom, desk and dressing area. All linens and towels are provided. All meals and activities are also provided.

Campers check out of motel by 11:00am on Sunday, September 15, 2019

Camper Contact Information

Name

First Name

Last Name

Verify Email

Cell Phone Number

Address

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Retreat Ticket Information

Payment Options

You may choose to pay in full today or pay a $25 deposit.

Pay In Full

Deposit Only

Choose Today's Payment Option (Choose Only One) *	Quantity
$25 - Pay In Full ($25/person)
$25 - Deposit Only ($25 reserves your spot. Balance to be paid later.)

Payment Date

If choosing to pay the deposit only now, when would you like to be billed for the balance?

Family Information

Please provide the following information to complete your registration.

Full Names and Tshirt Sizes of all Parents/Guardians/Caregivers Attending:

Full Name of Child #1

Age of Child #1

Diagnosis (if Applicable)

T-shirt Size for Child #1

Full Name of Child #2

Age of Child #2

Diagnosis (if Applicable)

T-shirt Size for Child #2

Full Name of Child #3

Age of Child #3

Diagnosis (if Applicable)

T-shirt Size for Child #3

Full Name of Child #4

Age of Child #4

Diagnosis (if Applicable)

T-shirt Size for Child #4

Full Name of Child #5

Age of Child #5

Diagnosis (if Applicable)

T-shirt Size for Child #5

Full Name of Child #6

Age of Child #6

Diagnosis (if Applicable)

T-shirt Size for Child #6

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