Teen Retreat Registration

*NOTE to youth leaders and pastors: If you would like to sign up a group of people or your entire youth group, please contact us directly at camp@lamoka.com.

Name*
First Last
Phone*
Email
Attendance Options
*NOTE: in 2020, because of COVID guidelines, ALL teens must be accompanied by a youth leader, pastor or adult (one pastor, leader or adult can be responsible for multiple young people or a group of young people as long as they have permission from the parents of each child). Teens without an adult or youth leader WILL NOT BE ALLOWED TO STAY OVERNIGHT, but may attend if they go home to sleep. Please contact us for more information. We apologize for the inconvenience.
- I will be attending with a youth leader, pastor, or adult who will be responsible for me
- I will not be attending with an adult or leader, and will be going home at night, and returning in the morning.
Name the leader, pastor or adult who will be responsible for you and attending with you?*
Life Threatening Conditions
*Please list any and all life threatening conditions you or your group may have.
Would you like to add this year's T Shirt for $12?*
*This shirt will be available at the retreat for $15 while supplies last.
- No thank you
- Yes ($12)
T-Shirt Size (Men's Sizes):*
Terms of Service*
- I agree to the above statement and I give permission for this camper to attend camp
Payment Options*
Coupon
Total Due Today
$0.00
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