Taconic Retreat & Conference Center
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Register Online
$150 per camper ($50 deposit required)
Camper's Name:*
Street:*
City, State ZIP:*
Home Phone:*
Birth Date:*
Grade Completed:*
Camper's Home Church:
Parent E-Mail Address:
Cabin Mate Preference:
Fathers Name:
Address:
Cell Phone:
Work Phone:
Mothers 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 to make your $50 deposit. This will hold your reservation. No reservations will be held without a deposit.


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