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Fall Rake Weekend
Nov. 8-11 | Price - Free! | Everyone
Check-In
-
4pm on
F
riday, Nov. 8th
Check-Out
-
11am on Monday
, Nov. 11th
Registration Deadline -
Nov. 1st
If you would like a printable Registration Form please click below:
File Size:
96 kb
File Type:
pdf
Download File
Registration
Fall Rake Weekend
Camper Info
*
Indicates required field
Name
*
First
Last
Birthdate (mm/dd/yyyy)
*
Sex
*
Male
Female
Phone Number
*
Email
*
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Home Church
Home Church
*
Is there any group or persons you would like to room with?
*
Emergency Contacts
Emergency Contact #1
*
First
Last
[object Object]
Relation
*
Phone Number
*
Emergency Contact #2
*
First
Last
Relation
*
Phone Number
*
Insurance
Insurance Company
*
Insurance Policy #
*
Billing Address
*
Line 1
Line 2
City
State
Zip Code
Country
Health
Please list any current medications and how often you take them.
*
Please list any dietary needs. Please note, our Kitchen Staff can accommodate allergies, not preferences.
*
Please list any food, medication, and/or insect allergies and describe reaction as well as management of reaction.
*
Waiver
Please click here to see our Waiver Form.
Check whichever option applies:
*
Adults (18+) - I agree to the terms of the waiver.
Minors (-18) - As a legal guardian or parent of the registered minor I agree to the terms of the waiver
Notes or Comments
Comment
*
Submit Registration