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Breakaway Camp 2 Hold Form
Breakaway Camp 2 Hold Form
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
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
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
*
Email
*
Your Address
*
Street Address
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Church Employee or Church Contact?
*
Church Employee
Church Contact
Your Title:
Your gender:
*
Male
Female
Date of Birth (to avoid duplicate names in online system)
*
Month
1
2
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5
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Day
1
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Year
2025
2024
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2015
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1920
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.
What method will you pay for camp deposit?
*
Mail a check to Tall Timbers
Pay by credit card with this form
Number of male chaperones
Quantity
*
Price:
$50.00
Quantity
Number of male students
Quantity
*
Price:
$50.00
Quantity
Number of female chaperones
Quantity
*
Price:
$50.00
Quantity
Number of female students
Quantity
*
Price:
$50.00
Quantity
Total people in your group:
Total Deposit Amount ($50 per person due)
$0.00
Number of male chaperones
*
Number of male students
*
Number of female chaperones
*
Number of female students
*
Total people in your group:
Total Deposit Amount by check ($50 per person due)
Rates and Lodging:
Our basic rate is for a cabin stay with no linens provided. Lee Lodge hotel rooms are available on a first come, first-served basis for an additional $30 per person. Each Lee Lodge room holds two full size beds with a bathroom/shower with towels and bed linens provided.
Choose Lodging
*
Lee Lodge
Cabins
Choose from the following:
*
I would like my entire group (both genders) in Lee Lodge
I would like all of the females in my group in Lee Lodge
I would like all of the males in my group in Lee Lodge
Other scenario (explain below)
Type any special needs in regards to lodging below; i.e. no stairs, handicap, etc.
Please choose one security question of your choice for us to set up your online registration and provide the answer below:
*
What is the name of the city in which you were born?
What is the name of the elementary school you attended?
What is your favorite color?
What is your mother's maiden name?
What is your pet's name?
Answer:
*
Payment for Deposit
Deposits must accompany this hold form to secure spots at camp. If your church prefers to send a check, and you chose "mail a check to Tall Timbers," we must receive your check no later than 2 weeks from the submission of this hold form, or your spaces will be released. DEPOSITS ARE NON-REFUNDABLE.
Credit Card Payment for Deposit
*
Card Details
Cardholder Name
Δ
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