Breakaway Camp 1 Waiting List

Camp Dates: June 24-26, 2021

Breakaway Camp 1 is now capped at 75% capacity due to COVID-19 restrictions. Please fill out this form to give us basic information and be put on a waiting list until space opens up.
Did your church attend Tall Timbers for camp before this year?*
- Yes
- No
Church Name / City / State*
Church Name*
Church Billing Address*
Street Address City State ZIP Code
Church Phone*
Church Email (if no email, type none)*
Are you a NEW contact person for this church registering for camp?*
- Yes
- No
Your name:*
Your Cell Phone*
Primary Contact Name*
Your gender:*
- Male
- Female
Permanent Address*
Street Address City State ZIP Code
Church Employee or Church Contact?*
- Church Employee
- Church Contact
Your Title:
Date of Birth (to avoid duplicate names in online system)*
Primary Cell Phone*
Email*
How many spots are you reserving for camp?
You must have 1 adult male per 8 male students and 1 adult female per 8 female students. Your primary adult leader for each gender must be, at minimum, 21 years of age.
*We will not take a deposit from you until space opens up for this camp.
Number of male chaperones*
Number of male students*
Number of female chaperones*
Number of female students*
Total people in your group:

Breakaway Camp 1 is now capped at 75% capacity due to COVID-19 restrictions. Please fill out this form to give us basic information and be put on a waiting list until space opens up.