On Track Youth Fall Retreat 2026

Cost: $80 (due October 14th)
After Oct. 14th = $90
Family Discount (Each Additional Youth): $50/youth

Arrive at PLC on Friday, October 23rd at 7:00pm
Pick Up at PLC on Sunday October 25th at 12:30pm

Retreat Location:
Promised Land Camp
301 Boy Scout Road
Conestoga, PA 17516

What to bring:
Sleeping Bag/Pillow
Bible, Notebook, Pen
Good and Old Clothes

Emergency Number: Dennis' Cell (717) 989-5408

Name(s) of Youth

Phone

Address

Age (s)

Grade

7th 8th 9th 10th 11th 12th

Payment

I, the parent or caretaker, do hereby understand the various activities that said person will participate in while active with On Track Youth Ministry and do hereby hold harmless the Youth Staff of said organization, for any bodily injury, disease, or loss/damage to any property or appliance of said person. In case of medical emergency, I understand every effort will be made to contact parent or caretaker. In the event no one is able to be contacted, I hereby give permission to the physician selected by the On Track Youth Ministry representative to hospitalize and secure proper treatment for, and order injection or anesthesia or surgery for, the person named above.

Authorize Do Not Authorize

Insurance Company

Policy #

Emergency Contact Name

Emergency Contact #

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

On Track Youth Fall Retreat 2026

Description

Please Fix the Following