GKC 2024 Chi Rho Mid-Winter Registration

February 7-9, 2025

7:00 p.m. Friday to 2:00 p.m. Sunday

Registration Cost: $190.00

Registration will close on January 24 at 11:59 p.m.

Thank you for registering for the 2025 Chi Rho Mid-Winter Event. We suggest that you scroll down the page to see the information requested before beginning the registration process.

This camp is intended to be accessible for all youth in the region, if price is an issue please apply for a scholarship.

Every youth camper must fill out a registration.

If you have any questions, call (913-669-4782) or email [email protected] before beginning the online registration.

To complete a registration you will need the following information for each youth:

Youth "Camper" Name
Date of Birth
Current Grade
Mailing Address, City, and Zip
Email Address that is checked at least once a week.
Name & Phone Contact for Parent/Legal Guardian
Name of Your Church and City/Town
Medical Information (ie: Insurance number and policy, Doctor Name & Number)

You are registering for:

2025 Chi Rho Mid-winter ($190.00)

What Congregation do you attend? (Choose from the dropdown menu):

Convenience Fee

$0.00

Would you like to make an additional donation to help more campers attend camp?

Running Total

$0.00

Total

$0.00

Youth / Camper Information

Youth First and Last Name

Youth Date of Birth

Gender

Is there anyone you want to room with? (This is not guaranteed but will be taken into consideration.)

Current Grade

Is this the first year your Youth has attended a Midwinter Event?

Camper Email: Updates about Midwinter are sent via email. Please list an email address that is checked at least once a week.

Youth Mailing Address

How did you hear about this camp?

Parent/Guardian with Legal Custody

Parent/Guardian First and Last Name

Parent/Guardian Address

Relationship to Youth

Insurance Information

If your Youth requires medical treatment while at Midwinter, your family's or youth's health insurance information will be used at the hospital. Please provide that information below.

Health Insurance Carrier or Plan Name

Policy or Group #

Date of Birth of Policy Holder

Youth Medical Information/ Dietary Needs

Please list any medical conditions/medications that a physician should know before treatment.

List and describe any Food Allergies or special Dietary Needs (including severity of allergy)

Name of Youth's Primary Doctor

Primary Doctor's Phone Number

Other Important Information

Is there anything else you would like the directors to be aware of?

What have we forgotten to ask? If your explanation about your youth's health exceeded the space above, please provide additional information about the youth that you think is important or that may affect the youth’s ability to fully participate in the Midwinter program by emailing Kylie Graham our Camp and Conference Coordinator ([email protected]).

Consent and Release

Permission to Photograph

With your permission, the Greater KC Region's Ministerial staff and our volunteer camp staff (counselors and directors) will photograph or video tape your child for the express purpose of promoting the Region's Youth Ministry, Children's Ministry, and Summer Camp (outdoor ministry) programs through print media, digital media, or Internet platforms. Further, the staff of Tall Oaks Conference Center (the facilities the Greater KC Region rents to host our programs) has permission to photograph or video tape your child for the express purpose of promoting their facilities and ministry of hospitality through print media, digital media, or Internet platforms. Below you can choose to give your permission or not.

Permission to Photograph

I/We Authorize the Region to photograph or video tape my child/youth.
I/We DO NOT Authorize the Region to photograph or video tape my child/youth.

MIDWINTER RETREAT PERMISSION/YOUTH COVENANT

This youth has my permission to participate in the Midwinter Retreat of the Greater Kansas City Region, Christian Church (Disciples of Christ). I will not hold the GKC Region, Tall Oaks conference center, the ministers, or the adult leaders responsible for liability in injuries, or accidents that might occur during this event and by this document do release them from any liability. I authorize any of the ministers or youth leaders to take my child to a licensed physician or hospital for any emergency, medical aid, or hospitalization required during the event. I also request that the ministers/leaders make a reasonable attempt to contact me in the event of such an accident. I understand that rules and regulations will be established governing participation as part of any sponsored group, and conduct during the event. I have instructed my child that she or he must abide by those rules. I also give consent for my child to be appropriately photographed within the context of the event to be used in the website, print, and other promotions of this Regional Youth Event as well as other events in the future.

By checking this box the youth and parent(s) provide their digital signature and agree to uphold the Community Covenant.*

You cannot register for CYF Midwinter without agreeing to uphold the Community Covenant.

Billing Information

Name

Payment Method

Credit Card
Check

Credit Card

Visa
Mastercard
American Express
Discover

Address

Phone Number

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