Camper's Name *
Camper's Name
Birthday *
Gender *
This is based on the grade that the campers HAS JUST COMPLETED!!!!
Parent/Guardian's Name *
Parent/Guardian's Name
Photo Permissions *
Every camp experience includes a group photograph which is given to all participants, used in a camp display, and posted on our website. Do you give permission for individual and small group pictures of your youth or child to be taken and posted on our website or used in publicity brochures and posters for future camps? If a choice is not marked, it will be assumed that your child’s photo CAN be used for publicity.
Parent/Guardian Number *
Parent/Guardian Number
Emergency Contact Number *
Emergency Contact Number
Camp Covenant *
• I will come to camp expecting to grow in my faith and in relationship with others, becoming a special part of the camp community. In order to do this, I covenant to follow all the rules and guidelines set by the Christian Church in Alabama Northwest Florida and any others set for this event. With this, I commit myself to the following: To be on time, attend and be attentive for all camp/conference activities and participate in them fully • Have fun and make sure everyone else has a great time • To respect each other regardless of age and to respect others’ feelings and thoughts • I will not go from adult to adult until I get the answer I want • Be myself and open to making new friends • Be inclusive at all times • Cooperate with the counselors, keynoter, director and other staff members at all times • Be respectful of God’s beauty in this special place and only leave footprints behind • To take all that I learn about God and share it with my friends, family and church I also agree to follow all camp policies as listed below: Summer Camping Program Policies • Participants are expected to remain for the entire event. No one should expect to arrive late or leave early without prior permission from director. The only visitors will be those invited prior to camp by the director. • No one, including counselors, will leave the camp without special arrangements with the director. • All cars will be parked for the duration of the event. Keys will remain in the possession of the director. • Events for youth in Alabama-Northwest Florida are “smoke free”. • Possession or use of intoxicating beverages, drugs or marijuana is prohibited. Violators will be sent home. • Stewardship of camp property is important. Camp must be left in as good or better shape than it was found upon arrival. Repair of damage to property will be paid by the person(s) responsible. • Food must be kept out of the dorm area. If you have special foods, arrangements can be made with director. • Dorms are off limits to members of the opposite sex. • Offensive, insensitive and foul language is not acceptable. • Cell Phones are not permitted. If you must bring one to camp You must turn in to the director
Do you have any health problems? *
Are you currently under the care of a physician or psychologist? *
Do you expect to have any difficulty with normal event activities? *
Do you have any food or other allergies? *
Do you take any prescription medication? *
In case of emergency, I hereby give permission to the physician selected by the camp director to hospitalize, order injections, anesthesia or surgery for the child named above in order to secure necessary, proper medical care. I understand that I will be contacted immediately in the event that something unforeseen happens requiring my attention. I release the YMCA-Hargis Retreat staff and management, camp directors and counselors, and the Christian Church (Disciples of Christ) in Alabama-Northwest Florida and its staff, from all responsibilities in case of sickness or accidents causing injury occurring during camp. I have provided proof of insurance to those in charge.
Camp Costs *
Tiered pricing offers the opportunity for you to take an active role in supporting more closely the true cost of the camp experience and/or helping other campers to have their own Christian Church (DOC) in ALWNFL Experience, if your financial situation allows. The choice to move up to a different tier is strictly that, a choice to pay a higher amount that more accurately covers the cost of a full week of camp at Christian Church (DOC) in ALWNFL. Genesis Camp (K/1st Grade) and Discovery Camp (2nd Grade/3rd Grade) Tier I Cost:: $170 before June 1st and $200 after June 1st Tier II Cost: $195 before June 1st and $225 after June 1st Tier III Cost: $220 before June 1st and $250 after June 1st Junior Camp (4th Grade/5th Grade), Chi Rho Camp (6th, 7th, and 8th) and CYF Conference (9th Grade-12th Grade) Tier I Cost:: $280 before June 1st and $330 after June 1st Tier II Cost: $330 before June 1st and $380 after June 1st Tier III Cost: $380 before June 1st and $430 after June 1st Tier #1 is Christian Church (DOC) in ALWNFL Summer Camp's historical rate. This rate is a heavily subsidized rate and does not reflect the full per-camper cost associated with providing summer camp programs. Tier #2 is between the subsidized published camper rate and the full cost of providing a Christian Church (DOC) in ALWNFL summer camp program for each camper. Tier #3 accounts for the full cost of providing a Christian Church (DOC) in ALWNFL summer camp program including the expenses of the volunteer counselors’ lodging, meals, and other expenses.
Payment Method *
Payment Arrangements Please choose ONLY ONE method of payment. A payment MUST be submitted with this registration.

AFTER HITTING THE SUBMIT BUTTON ABOVE CLICK HERE TO BE DIRECTED TO THE Alabama-Northwest Florida PAYMENT PORTAL.  By registering for this event held by the Alabama-Northwest Florida Region, you are agreeing to the terms of the REFUND POLICY.  If you have questions or encounter problems submitting your registration, please call Susan at 205-425-5245.