Camp Christikon Registration- 2024

We are so excited to be heading back to Camp Christikon this summer in Montana! We will be driving our to Montanta together. We'll leave from Good Shepherd on June 22nd and return on June 30th. This trip is open for current middle school students- grades 5-7.

The cost of the trip is $650 with scholarships available. This cost covers transportation, hotels, and the cost of the camp registration. If you have any questions, please contact Ally Reitz at ally@goodshepherdmn.org.

Youth Name

Youth Phone

Parent/Guardian 1

Parent/Guardian 1 Phone

Parent/Guardian 2

Parent/Guardian 2 Phone

This address will receive a confirmation email

Address

Current Grade Level

5th 6th 7th

Accommodations (Please select all that apply) I have limited mobility, but can board a bus with no assistance. I am a full-time wheelchair user. I have a sensory processing disability and am sensitive to light and/or sound. I must limit my exposure to sun or heat for medical reasons. I am medically prohibited from handling certain food products. I am medically prohibited from being around animal allergens. I have an allergy, food sensitivity, or other condition that requires a special diet.

Please provide any additional information regarding necessary accommodations for the trip (i.e. specific allergies, medication needs, etc.):

Emergency Contact Name

Emergency Contact Relationship

Emergency Contact Phone

I am interested in being an adult chaperone!

Yes! No!

Please list interested adults (must be 21+):

Trip Deposit

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Camp Christikon Registration- 2024

Description

Please Fix the Following