Children's Retreat - South Mountain Baptist Camp

Church Information

Church Name*

Church Phone*

Contact Name*

Contact Phone*

Email*

Would you like to to receive the registration packet by e-mail or postal mail?*

E-mail only
Mail to the church
Mail to my address

Church Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Contact Information

Contact Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Retreat

Select your first choice of retreat dates:*

October 2-3, 2026
October 9-10, 2026

Select your second choice of retreat dates:*

I am only able to attend my first choice.
October 2-3, 2026
October 9-10, 2026

Camper Information

Number of campers attending

*Note: Chaperones are required at a ratio of 1 adult per 6 campers. Coed groups REQUIRE coed chaperones.

Female Campers

Total Fee: $85 (Deposit $30 + Balance $55)

Price: $30.00

Male Campers

Total Fee: $85 (Deposit $30 + Balance $55)

Price: $30.00

Female Chaperones

Total Fee: $85 (Deposit $30 + Balance $55)

Price: $30.00

Male Chaperones

Total Fee: $85 (Deposit $30 + Balance $55)

Price: $30.00

Underaged Campers (Ages 0-4)

Total Fee: $35 (Deposit $30 + Balance $5)

Price: $30.00

Total

$0.00

Deposit Information

A deposit of $30 is required for each person (campers & chaperones) to confirm your reservation 2 weeks after your tentative reservation is made.
This deposit is NOT refundable under ANY circumstance.
One deposit is applied to each camper fee, extra deposits may NOT be applied to a group's balance.
Deposits may be made with check or money order payable to:

South Mountain Baptist Camp
3558 Baptist Camp Rd
Connelly Springs, NC 28612 The total fee for this retreat is $85. The balance of $55 per camper will be due 2 weeks before your event.

Cabin Preference

Cabin assignments are base on group size and the order deposits are made. If you have a cabin preference, please let us know here. We cannot guarantee cabin assignments.

No preference
Hope Haven (16 beds - 2 rooms of 8)
Wilkies Grove (18 beds - 3 rooms of 8)
Faith Lodge (28 beds - 2 rooms of 8, 2 rooms of 6)
Lincoln Avenue (28 beds - upstairs: 2 rooms of 6, downstairs: 2 rooms of 6, main room has 4 beds)
Pleasant Brook (28 beds - 2 rooms of 8, 2 rooms of 6)
Harris Fellowship (46 beds - upstairs: 3 rooms of 6, 1 room of 8, downstairs: 2 rooms of 10)
Pleasant Hill (48 beds - 2 rooms of 22, 2 rooms of 2)

I have read, understood, and agree to the registration policies listed on this form.*

Yes

Authorized Church Representative's Signature*

Printed Name*

Children’s Retreat

SMBC Children's Retreat Registration Form - Fall 2026

Church Information

Contact Information

Retreat

Camper Information

Number of campers attending

Deposit Information

Certifications

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