Valentine Float Trip (3-6 August 2022)

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Register your youth

Cost: $150--includes everything once you get there: •meals starting with Wednesday night supper through breakfast on Saturday, •rental of float equipment (tubes or kayaks), and • state park camping w/showers (extra minimal cost for showers because they are metered) at Smith Falls State Park.

When: Depart--Wednesday late afternoon/evening, Return--Saturday after clean-up at camp.

Participant's Name

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Birthdate

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Grade or Adult

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Please select one option.

1st 2nd 3rd 4th 5th 6th 7th 8th 9th 10th 11th 12th adult

Floatation Device Preference (Thurs.)

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Please select one option.

Kayak Tube Double Kayak (limited #'s) Canoe I have my own

Floatation Device Preference (Fri.)

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Please select one option.

Canoe Kayak Tube I have my own

Payment (minimum deposit $25)

($25) ($150)

Amount

Parent's Name

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Phone

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Address

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Email

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This address will receive a confirmation email

To which church do you belong?

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If you are not connected with a church home, would you like to find out more about Our Redeemer?

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Please select all that apply.

Yes No

If your child has allergies or other health concerns that we should know about, please fill out the youth medical information form (located on the website: OurRedeemer.life). Thank you.

Credit/Debit Card Number

Expiration Date/CVC

Name on Card

Card Billing Address

Description

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