HIGH POINT FALL RETREAT 2025

2026 FALL RETREAT REGISTRATION

November 20-22, 2026
Camper Personal Information
Camper Name

First NameLast Name
Camper Birthday

MonthDayYear
Camper Age
Camper Gender
Camper Cell Phone Number
Format: (000) 000-0000.
Parent/Guardian Information
Parent/Guardian(1)

First NameLast Name
Parent Cell Phone
Format: (000) 000-0000.
Parent/Guardian(1) Email
example@example.com
Parent/Guardian(2)

First NameLast Name
Parent/Guardian(2) Cell Phone
Format: (000) 000-0000.
Parent/Guardian(2) Email
example@example.com
Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact
Name

First NameLast Name
Phone Number
Format: (000) 000-0000.
Relationship to Camper
Camp Information
Are you attending as part of a church group?
If so, what church?
Medical Information
List of any diseases, physical or mental limitations
Medications currently taking and purpose
Allergies (food, medical, insects, etc.)
Restricted Activities
Family Physician

First NameLast Name
Physician Phone Number
Format: (000) 000-0000.
Family Medical Insurance Carrier
Policy Number
Parental Consent and Liability Release
I understand that High Point has high-risk activities and, due to the nature and its cost, camp insurance is not a possibility. I personally assume all risk for this teenager's safety during his or her weekend experience.

I agree that High Point Camp may use photographs and/or video of my teenager during their stay at camp; without liability and without expectation or receipt of compensation. Including for example, such purposes as publicity, illustration, advertising, and web content.

I have read the terms and conditions located on the High Point website carefully, and I agree to all policies written herein. I personally assume all liability.
I agree with the Parental Consent and Liability Release Statement
Parent/Guardian Signature

High Point Fall Retreat Payment (select choice)

High Point Fall Retreat (registration fee is non-refundable)

$125.00

Enter coupon

Total

Credit Card

Should be Empty:

2026 FALL RETREAT REGISTRATION

Camper Personal Information

Parent/Guardian Information

Emergency Contact

Camp Information

Medical Information

Parental Consent and Liability Release

High Point Fall Retreat Payment (select choice) *

Credit Card

High Point Fall Retreat Payment (select choice)