Pilgrim Youth Camp 2020 Registration

PYC '20 Registration Form

Fill out the form carefully for registration
Name*

First NameMiddle NameLast Name
Birth Date*

MonthDayYear
Gender*
Grade in School*
Your Age*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail*
Phone Number*

Area CodePhone Number
Name of church that you attend (Plus Name of Pastor)*
Listing of allergies and medications that you are taking:*
I attest that I have read the camp rules, and will abide by them fully.
Your Name*

First NameMiddle NameLast Name
I hereby give permission for the above named person to attend PHYC, and to be given treatment for any injury or illness by the camp nurse, attending physician, or hospital. I also give permission for the camp nurse to dispense Tylenol (acetaminophen) if requested by the camper.
Name of Parent/Guardian

First NameMiddle NameLast Name
NOTE: The registration fee can be paid upon arrival.
Should be Empty:

PYC '20 Registration Form