Registration Deadline: Wednesday, October 9th

Cost: $50

Register and Pay Online:

Student Info
Student Name *
Student Name
Student Phone *
Student Phone
Gender *
Grade *
Emergency Contact Info
Parent Name *
Parent Name
Parent Number *
Parent Number
Parent Name
Parent Name
Parent Number
Parent Number
Release and Permission
Parent Name *
Parent Name
I give permission for my above named child to attend the ELEVATE Middle School Retreat on October 18-19 at Camp Comeca in Cozad.
Date *
Please enter the date you are filling out this form.
Medical Form
Student Name *
Student Name
Address *
Date of Birth *
Date of Birth
Insurance Info
Phone *
Last Date of Tetanus Shot *
Last Date of Tetanus Shot
Parent Name *
Parent Name
MEDICAL AUTHORIZATION AND RELEASE: In case of medical emergency I understand every reasonable effort will be made to contact the student's parent(s) or guardian(s), using the information on the registration form. In the event parent(s) or guardian(s) cannot be reached, I give permission to the physicians and hospitals selected by the above participant's group leader or retreat staff to administer to the child named above the medical and surgical treatment then believed to be in the best interest of the child. The medical information on this form is complete and correct. I shall not hold the leaders of the ELEVATE Retreat or Camp Comeca liable for any injury to the participant while on the retreat. I certify that I am authorized to grant this authority and release.
Date *
Please enter the date you are filling out this form.
By signing this permission form you are agreeing to pick up your son or daughter from the Camp Comeca should they become sick, homesick, or behave inappropriately.


Packing List

What to Bring:

  • Bible

  • Notebook

  • Pen

  • Toiletries (toothbrush, deodorant, soap, shampoo, etc.)

  • Towel

  • Bedding (sheets and blankets or sleeping bag)

  • Pillow

  • Weather appropriate everyday clothes for indoor and outdoor wear (jeans & t-shirts/sweatshirts)

  • Close-toed, comfortable shoes (for activities)

  • Flashlight

  • Medication you take

  • Earplugs

  • Snacks (You don’t need a bunch, we are only going to be gone one day.)

  • Money for concessions

What NOT to Bring:

  • Alcohol, cigarettes, drugs, etc.

  • Fireworks, weapons, etc.

  • iPad or tablets

Clothing Guidelines:

Dress comfortably and modestly.



Friday, October 18

  • 7:00 | Registration/Check-In

  • 8:00 | Welcome/Games

  • 8:30 | Session 1

  • 10:00 | Small Group Discussion Time

  • 10:45 | Late Night Activities

  • 11:30 | In Cabins

  • 12:00 | Lights Out

Saturday, October 19

  • 8:30 | Breakfast

  • 9:30 | Morning Games/Load up

  • 10:30 | Session 2

  • 12:00 | Small Group Discussion Time

  • 12:30 | Lunch

  • 1:30 | Breakout Sessions (you pick one)

  • 2:30 | Free Time

  • 5:00 | Cabin Time

  • 5:30 | Dinner

  • 6:30 | Evening Games

  • 7:00 | Session 3

  • 8:30 | Leave Retreat