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CAMPERS,

are you ready?!!

Middle School Retreat Form

Parent First Name*

Parent Last Name*

Camper 1 Name*

Camper 1 Age*

Email*

Phone*

Will your campers be staying overnight or be dropped off/ picked up every day?

Overnight

Drop off/ Pick up

Tshirt size camper 1*

Youth M

Youth L

Adult S

Adult M

Adult L

Adult XL

Adult XXL

Camper 2 Name

Camper 2 Age

Tshirt size camper 2

Youth M

Youth L

Adult S

Adult M

Adult L

Adult XL

Adult XXL

Camper 3 Name

Camper 3 Age

Tshirt size camper 3

Youth M

Youth L

Adult S

Adult M

Adult L

Adult XL

Adult XXL

Do your children have any allergies we need to be aware of?*

Are there any medical conditions we need to be aware of?*

Emergency Contact 1*

Emergency Contact 1 Phone*

Emergency Contact 2*

Emergency Contact 2 Phone*

I understand that my child will be photographed and filmed during camp. These images will be used for future promotion of Camp Glow on social media and other web based advertising.

If you need to reach your child during camp hours, you will be provided the name and phone number for our camp staff. We ask that children not have access to phones during camp hours. If they need to pack a phone, please instruct them that it cannot be out during camp.

The liability waiver must be completed prior to camp. Your child will not be able to attend without the completed form.

Please choose amount according to how many children are attending.

1 Child $200

2 Children $400

3 Children $600

Retreat *

$200

$400

$600

CAMP KINDLING
WITH MAKER AND KIN

3350 CAMP JULIA ROAD
KANNAPOLIS NC 28083

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