Get away . . . for a change!

Please fill out the following fields to register:

What are you registering for?

Please choose Your housing preference: GB - Guest Building CC- Come as a Child BQ - Blessed Quietness BI - Blissful Ignorance JN - Joyful Noise WN - White Noise (Other) Other:

For details on the housing options, visit the Women's Retreat page

Please tell us when you're coming: April 25-27 ($65) May 2-4 ($65) April 26 (Sat only - $35) May 3 (Sat only - $35)

Please enter the following information:

Camper Information
First Name:		Last Name:
Street Address:		City:
State:		Zip:
Tel:		E-mail:
FAX:		Cell:
Work:		Church Attending:
Emergency Contact
Name:		Relation to Camper:
Phone:		Work:
Initial below to signify you agree to the following statement:   "I understand that I must give permission before my child receives any over-the-counter medications. My child has permission to participate in all activities on or off the grounds. In case of a medical emergency for my child, I authorize Shiloh Bible Camp staff to act in their best judgment to seek medical attention through appropriate means, including ambulance transport and emergency room treatment. I also accept responsibility for expenses incurred through such treatments." "I give permission for Shiloh to use any photo or video of my family in publications. I release my right to any kind of remuneration for said photos or videos.” Camper: "I agree to abide by all camp rules"
Parent Initials:		Camper Initials:

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