2018 Cedarkirk Retreat




Anyone in the PCPC family is invited to join us at Cedarkirk for a weekend retreat November 16-18th. If you are interested in going, please complete the form. Your deposit of $100 will hold your spot and more information will be sent out in the near future. Family package includes two adults and their children.
First Name
Last Name
Address
City
State
Postal Code
Email Address to receive updates
Second Email to receive updates
Primary phone (Cell/Mobile preferred)
Secondary cell phone
Adult Weekend (2 nights & 5 meals)= $125 per person /Adult Saturday Only (2 meals) = $32
Weekend Cost per child ages 3-12 (2 nights & 5 meals) = $100 / Saturday Only Per Child ages 3-12 (2 meals) = $25
Family Maximum = $425. All activities are included in pricing. No cost for children under 3 years old but please include their names. A family includes two adults and their children.
I/My family is interested in attending
Adult Names
# of Adults (13+)
# of Children (Ages 3-12)
# Children Under 3 (no cost)
Name child #1 goes by:
Name child #2 goes by:
Name child #3 goes by:
A deposit of $100 will hold your reservation through our online payment system. The balance will be due by Nov 1 and you will receive an email with your balance due in October. Questions attn: Mary Johnson marylee@palmaceia.org
From time to time, PCPC uses children's photographs to showcase or advertise programs and camps. Please select below to agree (or not) to allow your child's photograph to be used in any of these publications.
Photography Release
Medical Consent and General Release
I/we do hereby release the staff and officers from liability of accident, illness or injury during his/her participation in the programs that my child is registered for at Palma Ceia Presbyterian Church. I/we authorize the persons presenting this form to call a physician and consent to any transportation, x-ray examination, anesthetic, medical or surgical diagnoses or treatment and hospital care which is deemed advisable for my/our child in case of emergency. It is understood that a conscientous effort will be made to notify me/us before such action is taken.
If you do NOT wish to consent to the medical and liability release, please contact Allison@palmaceia.org. Registration cannot be completed online.

REGISTRATION IS NOT COMPLETE UNTIL PAYMENT DEPOSIT IS RECEIVED.
You will receive a confirmation email from donotreply@blackbaud.com shortly. Please secure your reservation by clicking on the pay now button to pay your deposit by credit card. If you wish to pay by check, please make check payable to Palma Ceia Presbyterian Church and put 2018 Cedarkirk retreat in the memo line.


Are Required Fields