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Youth Group Retreat

TBE Youth Group Chapter Retreat
January 10-12, 2025
Camp Shalom - Ocala, FL
Cost: $400
The cost of the TBE Youth Group Retreat includes round trip transportation on an air-conditioned bus, room and board for two nights at Camp Shalom, all meals and snacks, Chapter Retreat Shirt, and all educational and social experiences.

Registration is limited to the first 50 people. All others will be placed on a waiting list! All participants must be paid members of our TBE Youth program (5 - 12 grade). 

Registration is open to 5-12 graders! Completed registration form is required and each participant must read and sign a regulations agreement. Half payment is due at time of reservation and balance will be due by December 16.
REGISTRATION CLOSES MONDAY, DECEMBER 16 WITH FINAL PAYMENT.

 Please note  there are no refunds after Monday, December 16. There are no refunds for those who miss the trip.

There will be a meeting for all trip participants on Wednesday, January 8 at 6:00 pm.
Rooming, rules and regulations will be discussed at that time. Parents must attend!!

Looking forward to an awesome chapter retreat!!! If you have any questions or concerns please do not hesitate to contact Rayna Engle, Youth Group Director (954)347-7530 or Rayna417@aol.com.
Youth #1 Information
Youth #2 Information
Youth #3 Information
Parent Information
If no parent 2 please put N/A in the box.
If no parent 2 please put N/A in the box.
If no parent 2 please put N/A in the box.
If address differs from parent 1 please put information in the box. If address is same please put N/A.
Emergency Contacts
Parents are always contacted first, however, in case of illness, accident or injury please list additional people below who can be contacted.
Please Include:
Full name
Relationship to your child(ren)
Phone #
Include the following information:
Name of Insured
Name of Insurance Company
Policy #
Include the following information:
Doctor Name & Phone Number
Parent Consent & Release
I give my child(ren) permission to participate in the TBE Youth Department's Chapter Retreat, January 10-12, 2025. In the event of an emergency, medical, surgical or otherwise, and i cannot be reached, I hereby give permission for my child to be transported to the nearest medical facility and specifically authorize the representative of TBE to select a physician and/or authorize medical treatment, including hospitalization, anesthesia, injection, surgery or other measures which they feel are in the best interest on my child. Further, I accept full responsibility for payment of any such services rendered.
Both parents need to sign (even if parents are separated or divorced). If there is no parent 2 please put N/A. 
Participant Agreement
I agree to abide by all rules and regulations of the TBE Chapter Retreat. I understand that violation of the rules may result in curtailment of activities, and or early departure home. 
Payment Agreement
$400 per child for Chapter Retreat
ACH, Credit Card & Debit Card Payment Information
(Credit card/Debit card payments will incur a 3% convenience fee, there are no additional fees for ACH payments)

Once you submit this form you will receive an email with a payment link & Schedule/Packing List. Please submit payment so we can confirm your child(ren)s enrollment in Youth Group Chapter Retreat. Thank you!

Thu, November 21 2024 20 Cheshvan 5785