Men's Retreat Registration

Name*

First NameLast Name

Address*

Mailing Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number*

Area CodePhone Number

Email

example@example.com

Home Church?

First time at New Hope?

Please describe any food allergies or dietary restrictions you have.*

Name of Emergency Contact*

Emergency Contact Phone Number*

Area CodePhone Number

New Hope Christian Camp Medical/Media Release Consent:

I have chosen to attend a programmed event at New Hope Christian Camp. I designate camp officials to act on my behalf, if necessary, in authorizing routine and/or emergency medical care for myself or for anyone listed on this registration form. I agree to hold harmless New Hope Christian Camp for any and all claims of injuries, causes for action, or liability related to use of all camp facilities. I further authorize the camp to use photos or video taken of myself or my family at camp for promotional purposes. By submitting this registration, I agree to the above.

Payment Information: (Pick which answer applies. If other, please enter amount.)*

$125.00 I am able to pay the full amount$65 I can pay halfOther

Checks are payable to:

New Hope Christian Camp

PO Box 52

Platte, SD 57369

You may also go to our website, www.NewHopeChristianCamp.org, navigate to our giving page, click donate, and pay your registration online through our Tithely Account if you prefer.

Registration is not complete until we have received payment for the weekend.

Signature*

PLEASE NOTE: If you want a printed copy of your registraation, you must click "Print Form" before you submit. Hitting submit will send the form to New Hope, and you will not be able to print a copy for yourself.