JDOK Youth Registration 2026

What is the JDOK Retreat? The JDOK Retreat is a retreat which will focus on Christian community, active prayer, practical service, and sharing faith.

Who can attend the JDOK Retreat? Young women from 7 to 18 years of age who are either JDOK or invited by a JDOK member

When is the JDOK Retreat? Friday, January 16 - 18, 2026.

Where will the retreat happen? Camp Allen Campsite 3.

How much does it cost? Early bird special is $25 through September 30, thereafter through October 31 the cost is $35

When is the deadline to register? October 31, 2025

Youth's Name

Prefers to be called?

JDOK members must be current with their dues. Please pay dues at https://www.doknational.org/page/PayYourDuesOnline If needed, your directress can help you access your JDOK number.

Are you a JDOK Member?

Yes No, I am a JDOK guest.

Who is your JDOK Directress?

JDOK Directress's Phone

JDOK Directress's Email

Youth's Date of Birth

Age (at time of Camp)

Grade

Address

Youth's Phone (if applicable)

T-Shirt Size

YM YL AS AM AL AXL A2XL A3XL

Parent/Guardian's Name

Parent/Guardian's Phone

Parent/Guardian's Email

This address will receive a confirmation email

I understand that my email address will be added to a Google Group in order to receive communications regarding the retreat.

Yes

First Emergency Contact

Relationship

First Emergency Contact's Phone

Second Emergency Contact

Relationship

Second Emergency Contact's Phone

If your church wasn't listed above, please enter the name of your church here:

Doctor (if none, please put N/A)

Doctor's Phone (if none, please put N/A)

Insurance Company (if none, please put N/A)

Insurance ID/Policy # (if none, please put N/A)

Insurance Group ID # (if none, please put N/A)

Insurance Phone # (if none, please put N/A)

Please upload a copy of Participant's Insurance Card (front and back)

Upload (8MB)

Please type your "Self Pay" if no insurance

Known Allergies & Reaction(s) (if none, please put N/A)

Over-the-counter medications NOT to give and reaction(s) (if none, please put N/A)

Regularly Taken Prescription Medication (include dosage and times taken) (if none, please put N/A)

Please list any dietary restrictions/allergies (if none, please put N/A)

Are there any life circumstances (death, divorce or change in family circumstances, Changes of school, ect.

Are there any health conditions in which the adult staff should be aware? Does the child have a physical, behavioral or an emotional disability? On 504 plan or IEP?

Release Of Liability I hereby release, relieve, indemnify, and hold harmless the Junior Daughters of the King, the Daughters of the King, Camp Allen and its employees, the driver of the transport vehicle, the Episcopal Diocese of Texas and its bishops, clergy, event coordinators, youth leaders, employees, representatives, and agents from any and all liability for any injury, illness, or property damage associated with my child’s participation in this activity or travel associated with this event. In the event that my child should require medical treatment and I cannot be contacted immediately, or if contacting me is not feasible because of an emergency, I hereby give consent to such treatment. The sponsors of this event do NOT provide insurance in case of injury or illness.

Yes No

My child has my permission to attend and participate in the Junior Daughters of the King Assembly at Camp Allen on January 17-19, 2025 sponsored by the Daughters of the King Episcopal Diocese of Texas. I further agree to my child riding in the automobile being used by my group to transport participants to/from Camp Allen. I confirm that my child is healthy and capable of participating in this event. I also confirm that my child is covered by medical insurance, or if medical insurance is not available to my child, I agree to be personally responsible for the costs of any medical treatment deemed necessary.

Yes No

I understand that photos or videos of my child and others may be taken during the event, and I consent to the use of my child’s photo or likeness by Junior Daughters of the King in promotional materials. I acknowledge/confirm that the information listed on my child’s application is true and accurate.

Yes No

I understand that in the event of an increase of the pandemic, all Covid related procedures must be followed by all participants. Additionally, the retreat date maybe changed or cancelled.

yes

Would you like to purchase a JDOK Handbook? ($20.00)

Yes No

If a scholarship is necessary, please contact your directress.

Payment (Select one of the following)

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

JDOK Youth Registration 2026

Description

Please Fix the Following