Taconic Retreat & Conference Center Time to Register for Summer Camp!!
Flash: ON

Register Online
$200 per session + $50 non-refundable registration fee
Camper's Name:*
Street:*
City:*
State:*
Zip:*
Home Phone:*
Birth Date:*
Grade Completed:*
Camper's Home Church:
Parent E-mail Address:
Cabin Mate Preference:
Father's Name:
Address:*
Cell Phone:*
Work Phone:
Mother's Name:*
Address:*
Cell Phone:*
Work Phone:
With Whom does the Camper Reside?:*
People authorized for camper pick-up (Must list two):*
Relation to Camper:*
Cell Phone Number:*
Emergency Contact (not parent):*
Relationship:*
Home Phone Number:*
Cell Phone Number:*
**PLEASE GO TO ONLINE PAYMENT


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