Kingswood Summer Youth Retreat!

Camper Application July 14-17, 2019

For the first time, this summer Kingswood is hosting a 3-night youth retreat!! Come join us for some fun in the sun as we enjoy swimming, boating and water games at Hathaway pond. When you are not relaxing by the water join others on a hike on the various trails throughout our 766 acre property! As the day comes to an end sit around the campfire for some stories, songs and of course, s'mores! And as always, leave your mark on Kingswood by placing a stone in our stone ministry.

This retreat is open to all youth ages 11-17 and will be supervised by trained former Woodsmoke adults including a certified first aider!

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* 1. Camper Information

Name

Age

Gender

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* 2. Parent/Guardian Information

Name

Email Address

Phone Number

Mailing Address

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* 3. Emergency Contact Information #1

Name

Phone Number

Relationship to Camper

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* 4. Emergency Contact Information # 2

Name

Phone Number

Relationship to Camper

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* 5. Does your camper have any dietary restrictions? If yes, please explain

Yes

(please specify)

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* 6. Does your camper have any allergies? If yes, please explain

Yes

(please specify)

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* 7. Please list any camper medications and other medical information:

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* 8. Please list any adults that have permission to pick up your camper

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* 9. I understand I must submit the separate "Summer Youth Retreat Permission Form" with my signature via email or by fax to Allison Wityk, by Sunday, 7/7/19

Yes

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* 10. Payment is due by Wednesday 7/10/19. I would like to pay the $125 Summer Retreat Camper fee by

Paypal to joncarr22@warwick.net under 'Pay for Goods and Services'

Cash/Check/Money Order to Kingswood Administrator at 1500 Hathaway Pond Rd, Hancock, NY 13783