To reserve dates for your rental retreat, contact our office at (413)447-8930 or lakeside@lakesideonline.org to check date availability and costs. We will need to know the size of your group as well as the housing preference.
Programmed Retreat Registration Form
Use this form to register for any of the retreats below. Use one form per retreat please, photocopies are acceptable or download at www.lakesideonline.org. To register, send this form, along with the full retreat fee to: Lakeside Christian Camp, 195 Cloverdale St, Pittsfield MA 01201.
Please check the retreat you are registering for:
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Family Retreats □ Mother & Daughter- October ___Adults x $110 = _______ ___Child x $90 = _______ □ Family
Christmas □ Mother & Daughter- March
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□ 30th Anniversary Weekend Lakewood/Wintonbury Lodge: ___Adults x $125 = _______ ___Child x $100 = _______ Cabin on Green: □ 30th Anniversary Day Only |
Youth Retreats- Individuals Only □ High School Snow Camp ___Youth x $140 = _______ □ Middle School Snow Camp Note: If participating in snow camp with your youth group, please register with church leader. Women’s Retreats □ Stitch & Stick- March
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Adult Last Name________________________First Name___________________□Male □Female
Adult Last Name________________________First Name___________________□Male □Female
Youth Last Name________________________First Name___________________□Male □Female Grade/Age____
Youth Last Name________________________First Name___________________□Male □Female Grade/Age____
Mailing Address________________________________________City/State/Zip __________________________
Family Email________________________________________________Home Phone ______________________
Congregation/City/State _______________________________________________________________________
Roommate Request __________________________________________________________________________
Medical Release
Insurance Carrier Group/Policy Number
___________________________________________________________
Emergency Name & Relation Emergency Phone
_____________________________________________________
I will not hold Lakeside Christian Camp & Conference Center or its staff responsible for accidents, claims, or damages arising from me or my child’s participation in retreat activities. I am responsible for any medical obligations incurred during the retreating period and give the Lakeside Christian Camp & Conference Center staff permission to seek medical treatment for me or my child in case of injury or illness. I also give Lakeside Christian Camp & Conference Center permission to use any photograph/video of me or my child, taken at the retreat, in future promotional materials for its programs.
Parent/Guardian or Adult Participant Signature__________________________________________Date
_______
Payment Information
□Check payable to Lakeside Christian Camp □Visa
□Mastercard □Discover
Cardholder’s Name____________________________Card Number ___________________________________
3 digit security code______________Expiration Date_______________________Amount $ __________________
Upon receiving your registration, you will receive a confirmation, receipt, and retreat information email.