Children’s Retreat

Church Information
Church Name*
Church Phone*
Contact Name*
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 Phone
Contact Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
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*
Female Chaperones*
Male Campers*
Male Chaperones*
Total*
Deposit Information
A deposit of $30 is required for each person (campers & chaperones) to confirm your reservation by October 16, 2023.
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
I have read, understood, and agree to the registration policies listed on this form.*
- Yes
Authorized Church Representative's Signature*
Printed Name*

Church Information
Church Name*
Church Phone*
Contact Name*
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 Phone
Contact Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
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*
Female Chaperones*
Male Campers*
Male Chaperones*
Total*
Deposit Information
A deposit of $30 is required for each person (campers & chaperones) to confirm your reservation by October 16, 2023.
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
I have read, understood, and agree to the registration policies listed on this form.*
- Yes
Authorized Church Representative's Signature*
Printed Name*

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Church Information