One Retreat

List Camper’s Home Church

Redemption Christian Church

Redemption Male Camper ($65.00)
Redemption Female Camper ($65.00)

Camper's Name

Camper's Address

Camper's Gender at Birth

Male
Female

Camper's Date of Birth

Age at the time of camp

Camper's Grade (2026/2027)

Has the camper been baptized by immersion?

Camper's T-Shirt Size

Preferred Room Bunk Mates (Roommates cannot be guaranteed but our team will do our best to accommodate for preferences)

Does your Camper have roommate preferences?

Primary Parent/ Guardian - Name

Primary Parent/ Guardian - Date of Birth

Primary Parent/ Guardian - Phone Number

Yes, it's okay to send me text messages including order confirmations, updates, event reminders, and event information. Message frequency varies. Message and data rates may apply. Reply HELP for help, STOP to cancel. View our terms of service & privacy policy.

Primary Parent/ Guardian - Email

Secondary Parent/ Guardian - Name

Secondary Parent/ Guardian - Date of Birth

Secondary Parent/ Guardian - Phone Number

Secondary Parent/ Guardian - Email

Additional Authorized Pickup

Check if you would like to add additional authorized pickups

Is there anything else we should know?

Describe any medical conditions the camper has (e.g., asthma, diabetes, seizures)?

Describe any food allergies the camper has

Describe any past behavior/discipline issues or difficulties that we should know about (so we can best support them)

Describe any recent trauma your camper has experienced that we should know about (so we can best support them)

Does your child have an allergy, special need, learning disability, or behavioral diagnosis you’d like to share so we are prepared to help him/her feel as safe and comfortable as possible?

A signed waiver by event participant or parent/guardian will be required before you can download your QR code. A link to obtain waivers for all registrants will be shown on the confirmation page.

Camp Illiana Refund Policy

To ensure fairness and accommodate the high demand for our camp sessions, Camp Illiana has implemented the following refund policy:

1. Cancellations More than 30 Days Before Session Start Date
- A $25 processing fee will be charged for cancellations made more than 30 days before the session start date.

2. Cancellations Within 30 Days of Session Start Date
- Cancellations within this period will result in a forfeiture of 50% of the camp fee.
- Alternatively, campers have the option to transfer their registration to another available session.

I have read and agree to the terms above.

I understand and agree that for events/trips/retreats/overnights/camp we assimilate children and students based on their biological sex into small groups and overnight sleeping arrangements.*

Scholarship Code

Do you have another code to apply?

Billing Information

Name

Credit Card

Visa
Mastercard
American Express
Discover

Address

Phone Number