Location
Thompson Lake Christian Retreat
Address 593 ACM Road South
Libby, Montana
Phone: 406-293-5832 *There is no cell service at camp. Please only call this number for emergencies.
Email: tlcretreat@easthaven.org
Camp Fees
$130.00 per camper
Adult volunteers who go to camp to work will be free. Registrations will not be processed without full
payment or an approved application. If the camper cannot afford camp, please contact Matt Watts.
Refunds
If you cancel 14 days or more days in advance (prior to July 18th), all camp fees will be refunded. If
you cancel AFTER July 19th there will be NO refund. Exceptions will be considered in the case of
illness or family emergency if requested in writing to Matt Watts.
Health Forms
Every camper is required to submit health forms prior to camp arrival. Campers without the forms will
not be admitted to camp. The health form is for our church staff only.
Please return registration, payment and health forms no later than Wednesday, June 29th to Matt Watts.
Please make your checks out to The River Church.
You may either drop off your paperwork to Roots Christian Fellowship or mail it to:
Roots Christian Fellowship, PO Box 1058, Corvallis, MT 59828
Email: youth@rootsfellowship.com
Contact Numbers:
Matt Watts (Roots) 803.427.2379 youth@rootsfellowship.com
Larry Lee (The River) 406.579.5758
Christey Lee (The River) 406.369.2351
(You KEEP this page)
Parent/Guardian - Contact Information
Parent/Guardian #1
First___________________ Last____________ Email _____________________ Lives with child: ⧠ Yes ⧠ No
Street Address __________________________________ Town/City _____________ State ___ Zip Code________ Home Phone
________________ Work Phone _________________ Cell phone _________________
Parent/Guardian #2
First___________________ Last____________ Email _____________________ Lives with child: ⧠ Yes ⧠ No
Street Address __________________________________ Town/City _____________ State ___ Zip Code________ Home Phone
________________ Work Phone _________________ Cell phone _________________
Emergency Contact Information – Alternate Pickup/Release
Emergency Contact #1
First Name ___________________ Last Name ___________________ Home Phone ________________
Work Phone ______________Cell Phone _______________ Email _____________________________
Relation to child ___________________ Authorized to pick-up youth ⧠ Yes ⧠ No
Emergency Contact #2
First Name ___________________ Last Name ___________________ Home Phone ________________
Work Phone ______________Cell Phone _______________ Email _____________________________
Relation to child ___________________ Authorized to pick-up youth ⧠ Yes ⧠ No
Medical Release Information
Insurance Information
Policy Number__________________________________ Name of Health Insurance Provider_________________
Primary Physician______________________________________________________________________________
Address______________________ Phone____________________________
Please list any severe medical issues, including any requiring maintenance medication (i.e. Diabetic, Asthma, Seizures).