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The Retreat at Silver Springs • 6455 East Silver Springs Blvd., Silver Springs FL 34488

Early Bird Registration thru May 15, 2025

On behalf of the The Florida Disciples Regional Church, thank you for registering for Church camp. We suggest that you scroll down the page to see the information requested before beginning the registration process. It will help you understand the registration process. We do not require campers to be vaccinated for childhood immunizations, we highly encourage it.

The Region does not share your information to third parties/partners. If you have any questions, call (352)438-0340 or email [email protected] before beginning the online registration.

Every camper must complete a registration.
We do not allow same-day registration at the camp facility.

A Parent/Guardian for this registration will provide their digital signature via a checkbox for the
"Parent/Guardian Consent & Payment Policy" section.

The Camper for this registration will provide their digital signature via a checkbox for the "Camper Covenant."

To Complete a Registration, You Will Need the Following Information for Each Camper:

Camper Name
Date of Birth
Gender
Grade Completed (this June)
Mailing Address, City, and Zip
Email Address of Parent/Guardian that is checked at least once a week.
Name & Phone Contact for Parent/Legal Guardian
1 Emergency Contact IF Parent Cannot Be Reached (Name and Best Phone Number)
Name of Your Church and City/Town
Medical Information (ie: Insurance, Doctor Name & Number)
If the camper takes medication, we will need that list with dosage information.
Vaccination History (yes/no)
Emotional/Social Health Questions
General Health Questions

Register for camp based on the grade your camper completes June 2025, not beginning in August 2025.

Camp UNO (grades K - 2 with a loving Adult) July 18 - 20: Registration Deadline: July 11

Registration Policy: All registrations and fees must be received by their due date. Registrations received
after that date can only be accepted with the camp director’s approval and if space is available.

The cost of providing food, housing, and programming at The Retreat at Silver Springs has steadily increased. Despite these increases, we have not raised camp fees in at least eight years. However, the reality of this decision has become a challenge that we can no longer continue to support. We've spent the past several months working to identify income and expenses, reviewing the costs of everything from insurance coverage to camp t-shirts and we've made the hard decision to increase camp fees beginning with the 2025 camp season.

We will continue to offer Regional Scholarships as our finances allow along with early registration discounts.

Camp UNO Fee(s)
Early Registration thru May 15th - $250 Adults and $150 Child K-12
May 16th - July 11th: $350 Adults and $250 Child K-2

REGISTRATION AND FULL PAYMENT DEADLINE: JULY 11, 2025

Camper Fee Payment [If you are mailing-in your payment or not making a payment at this time please enter: 1]

I am requesting a Scholarship

If you are requesting a Scholarship, you will need to fill out a Scholarship Application. Scholarship Applications for Summer Camp are available at: https://fldisciples.org/events-summer-camps/.

My church will pay part of my camp fee.

Select this option if your church has agreed to pay part of your camp fees.

Name of the Church paying for part of my camp fees.

Other individuals will be paying part of my camp fees.

Payment Note: If you have a message about your payment that you'd like to make the region aware of, please write your message below.

Payment Message

Type of Payment

Camper Name

Name preferred for nametag:

Address

Home/Cell Phone Number

Yes, it's okay to send me text messages including confirmations, changes, updates, and/or promotions. Message frequency varies. Message and data rates may apply. View our terms of service & privacy policy.

2nd Phone Number

Email: Updates about camp will be sent via this email address.

Gender

Male
Female

Preferred Pronouns

Date of Birth

Grade completed in school by June 2025:

Is this your first year attending camp?

Home Church (include city) [If no home church, enter NONE]

T-Shirt Size

Adult Attending Camp Information

Full Name

Relationship to Camper

Name preferred on nametag

Gender

Address if different from camper

T-Shirt Size

Parent/Guardian & Emergency Contact

If the parent/guardian is attending camp, please provide another emergency contact person

Parent/Guardian or Emergency Contact person

Relationship to Camper

Primary Phone Number

2nd Phone Number

Camp Uno will begin with registration at 3:00 p.m. on Friday, July 18, and close at 1:00 p.m. on Sunday, July 20. Registration deadline is July 11.

The camp fee is $150.00 for the child and $250 for the adult through May 15th. After May 15th, the camp fee increases to $250 for the child and $350 for the adult, so get your forms in EARLY!

Camper Information

DOES CAMPER HAVE HEALTH INSURANCE?

If "yes", please email a copy of the insurance card (front and back) to [email protected].. Make sure to include the campers name. The campers insurance is primary and the limited Florida Disciples Regional Church insurance is secondary. The Florida Disciples Regional Church insurance supplements only those accidents and illnesses that occur during camp.

Physician's Name [If no physician type N/A]

Physician's Phone Number: [If no physician type N/A]

Is applicant in good health and able to participate in all usual camp activities?

If not, please explain

Does camper have allergies (check all that apply):

Seasonal allergies

mildew/mold

Asprin

bee stings

penicillin

food allergies

sulfa type drugs

others

Please list specific food allergies or other allergies not listed

Asthma

HEALTH HISTORY - Check all that apply:

ADD/ADHD*

AIDS/HIV

Epilepsy

Ear Infection

Sinus infections

Sore throat

Stomach upsets

Measles

Constipation

Fainting

Sleep Walking

Bed Wetting

Operations

Diabetes

Chicken pox

Serious injuries

Chronic Condition of Heart/Lungs/other

Mental Health Concerns

History of communicable illness (like polio or turberculosis)

Neurodiversity Diagnosis

If yes, please give details below.

Yes, please explain:

Mental Health Concerns

If yes, please give details below.

Yes, please explain:

Please list other conditions, details of health history items marked above and any special concerns or illness that this camper has. This will assist the camp staff to help your camper have the most positive camp experience possible.

Date of last tetanus booster If you do not know date, enter time frame since booster.

Date of last physical exam. If you do not know date, enter time frame since physical exam.

I give permission for my child to receive "over the counter" non-prescription medications (i.e. Tylenol).

Special Dietary Needs

MEDICATIONS: All medications must be sent to camp in their original containers with labels to be turned over to camp staff at registration. A staff person will monitor and distribute medication, the dosage amount, the time medication needs to be taken, and any other specifications.

Medicine

Dosage and Frequency

Medicine

Dosage and Frequency

Medicine

Dosage and Frequency

Medicine

Dosage and Frequency

Medicine

Dosage and Frequency

Please provide any other information including physical/intellectual/emotional problems, learning disabilities, or recent changes in family status or living arrangements, which may affect the camper's experience.

Adult Camper Insurance/Health/Medication Information

DOES ADULT CAMPER HAVE INSURANCE?

Physician's Name [Type N/A if you do not have a physician.]

Physician's Phone Number [Type N/A if you do not have a physician.]

Date of last tetanus booster. If you do not know date, enter time frame since tetanus booster.

Date of last physical exam. If you do not know date, enter time frame since physical exam.

Are you in good health and able to participate in all usual camp activities?

Is there anything in your medical history that our nurse needs to be made aware of?

List allergies and any special medical conditions:

List any special dietary needs.

All medications must be turned in to the camp staff to provide safety for the people in your cabin.
All medications must be sent to camp in their original containers with labels to be turned over to camp staff at registration. A staff person will monitor and distribute medications as needed. This includes over-the-counter drugs as well. Please provide a list with the name of the medication, the dosage amount, the time medication needs to be taken, and any other specifications.

Dosage and Frequency

Name of Medication

Dosage and Frequency

Name of Medication

Dosage and Frequency

Name of Medication

Dosage and Frequency

Name of Medication

Dosage and Frequency

Name of Medication

Dosage and Frequency

Name of Medication

Dosage and Frequency

Name of Medication

Dosage and Frequency

Name of Medication

Dosage and Frequency

Our summer camp experiences depend on a commitment to live in an intentional Christian community by the participants and the adult volunteers. To do so, we agree to a covenant that helps manage our relationships with one another, our behavior within the community, and as a community. We require all participants to read and agree to our Camper Covenant below.

There are two sections that must be complete for registration process. Sections I and II will be filled out online.

Section I. Camper and Adult Covenant

The following are the general and specific expectations for those who are participating in all camps, conferences, and other events sponsored by the Christian Church in Florida (Disciples of Christ). By signing below, you (the camper) agree to the following:

• I will take part in all camp activities from beginning to end.

• I will cooperate with all camp leaders and obey the rules set for my particular camp.

• I will respect each and every person attending my particular camp, treating all people equally and with dignity.

• I will be responsible for the cleanliness and condition of any areas in which I am participating. (Graffiti, carving, cutting, mutilating, vandalizing, etc. will NOT be tolerated).

• I understand that language, clothing, and behavior considered offensive, foul, provocative, overtly sexual, belittling, or harmful in any way (as determined by the camp director) will NOT be tolerated.

• I understand that I am not to enter any cabins other than my own; I will respect everyone’s personal space.

• I will NOT bring any electronic devices (cell phones, radios, stereos, personal listening devices, games, tablets, televisions, etc.) to any camp. Such items will be confiscated and returned at the camp’s conclusion.

• I will NOT use tobacco products, alcohol, or any non-prescribed drugs during any camp.

• I will NOT bring candy, food, or snacks to any camp, unless arranged with the director.

• I will NOT bring fireworks, firearms, knives, or any other weapons to any camp.

• I understand telephone calls are only for emergency situations arranged by the director.

• If it is illegal, I cannot do it or have it.

• If I pose a real or perceived threat to myself, any other person, or the camp site I may be sent home immediately at the director’s discretion, and at the expense of my parent/guardian.

• I understand staff will have zero tolerance for offenses against this covenant.

By checking this box I agree that I have read the Camper Covenant above and agree to abide by the Camper Covenant.*

Checking this box represents your digital signature and authorization. You cannot register for camp without accepting the "Camper Covenant".

Camper Name

Adult Camper Name

Date

Section II. Parent/Guardian Consent & Payment Policy

The undersigned person represents that he/she is the custodial parent/legal guardian of the above identified participant. I give my consent for the above identified participant to attend the event identified on this form and some activities may take place off site. I understand photographs that include my youth could be taken at this event and consent for their use in future promotional materials and that a camp roster (which will include the campers name, address and email) will be distributed to each participant. In addition, I realize that I will be personally responsible for picking him/her up from the event if he/she violates any part of the Camper Covenant. In case of a medical emergency, I hereby give permission to the physician selected by the Event Director to hospitalize, secure proper treatment for, and to order injections, anesthesia and/or surgery for my child as named above. I also release the Florida Disciples Regional Church and its agents from liability in injuries beyond the limits of the health and accident insurance provided for in the event fee.

Registration Policy: All registrations and fees must be received by the Florida Disciples Regional Church, 6455 E. Silver Springs Blvd., Silver Springs, FL 34488, by their due date. Registrations received after that date can only be accepted with the camp director’s approval and if space is available.

Payment Policy: Registration forms are not processed, and campers are not considered “Registered” until complete camp fees have been received by the Florida Disciples Regional Church and every section of this form has been completed. Refunds will NOT be issued after the registration deadline. Any excepti0ns will be at the discretion of the Outdoor Ministry chairperson.

By checking this box I acknowledge that as the Parent/Guardian I give my consent for camper named on this form to attend this event. I also acknowledge that I have read the Check Out & Transportation Policy, and the Payment Policy and agree to adhere to both.*

Checking this box represents your digital signature and authorization. You cannot register for camp without accepting the "Section II Parent/Guardian Consent, Check Out & Transportation Policy & Payment Policy ".

Parent/Guardian Name

Date

BILLING INFORMATION

Name

Payment Method

Credit Card
Mail-In Check

Credit Card

Visa
Mastercard
American Express
Discover

Address

Mobile Phone Number

Event Registration Software by RegFox

Florida Disciples Region

2025 Summer Camp

At The Retreat at Silver Springs

June 8 - September 1

Register Today!

CAMPER REGISTRATION

Adult Attending Camp Information

Parent/Guardian & Emergency Contact

Insurance / Health / Medication Information

Camper Information

Adult Camper Insurance/Health/Medication Information

Covenant ll Consent Forms

Section II. Parent/Guardian Consent & Payment Policy

BILLING INFORMATION