Name:
Address:
City:
Phone:
e-mail:
State:
Zip:
Adults (18 & Over)
Men - list names
Women - list names
Youth (ages 4 - 17)
Boys - list name, age, and grade this Fall
Girls - list name, age, and grade this Fall
Ages 3 & Under
Boys - list names
Girls - list names
Camp Group Activities
Please list name of those who want to participate
Name:
Name:
Name:
Name:
Saturday: 9am - 12pm
Climbing Wall & Zip Line ($5)
(requires tennis shoes)
Saturday: 9am - 12pm
The Fly ($5)
(requires tennis shoes, minimum age - jr. high)
Name:
Name:
Name:
Name:
Online Registration Form
Use TAB key to move between fields (SHIFT TAB to go back)
Pre-Registration
$15 deposit required for each person 4 & over by 7/16/12.
Make your check payable to:
Lutheran Family Retreat
Mail to: Carroll Hackbart
3640 Flush RdSt. George, KS 66535Registration Questions?
Contact:
Carroll or Barb Hackbart
785-494-2425 orSaturday: 11:30am
Sand Dig - for children age 7 and under
Ivan or Barb Grimm
913-685-8360 or
Saturday: 2pm - 5pm
High Challenge Course ($5)
Name:
Name:
Name:
Name:
Saturday: 2pm - 5pm
Craft Room (fee determined by project)
Name:
Name:
Sunday: 1pm - 3pm
Air Rifles & Archery ($5)
Name:
Name:
Name:
Name:
Water Aerobics (no fee)
Name:
Name:
Name:
Name:
All fees will be collected at time of registration.
Attending: (Check all that apply)
Referred by:
Lutheran Family Retreat
August 3 - 5, 2012 Sonrise to Sunset
