Registration Form - Family Retreats
Please print registration form (one form per person) and fax to 863.696.1062
If you prefer, you may fax your registration form and pay on-line using our secure server.
(Just use the Registration box for fees to be paid - it will appear as a 'donation' but it is a payment)
Mother/Daughter or Father/Son Registration
(All ages are welcome. However, past participants recommend at least 4 years and up as activities are geared more to interactive ages. Child - 5-18 years old. Call or email for rates under 5 years of age.)
City:__________________________________ St:_______ Zip:_________________
Phone: (include area code)____________________________________________
_____Mother & Daughter Retreat October 5-6, 2012 ($53 adult/$37child)
_____ Sponsor a table decoration in a "WILD" theme (You will be given instructions)
_____Father & Son Lakeside Retreat Nov. 16-17, 2012 ($53 adult/$37child)
_____ Paintball Option: Add $15 and Waiver Signature
_____Optional Camp Out Extension
Nov. 18-19 Add: ($28 adult/$17 child)
$ Amount Enclosed:_______________________ $45 deposit per retreat or full payment.
Charge to: Mastercard Visa American Express Discover
(3% surcharge when using a corporate account credit card)
CC #______________________________________________________exp. date______
Billing address of cardholder if different from above:
Phone of card holder: __________________________________________________
Deposit is transferable but not refundable.