Camp Registration
Student Information
Student Name
*
First Name
Last Name
Age
*
Grade
*
Gender
*
Male
Female
Tee Shirt Size
*
XS
S
M
L
XL
XXL
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Does your student have any allergies, chronic illness, or medical conditions? If yes, please describe.
Is your student prescribed an inhaler? If yes, please explain any instructions.
Parent/Guardian Information
Name
*
First Name
Last Name
Parent/Guardian Phone Number
*
Parent/Guardian E-mail
example@example.com
Emergency Contact's Name
*
First Name
Last Name
Relationship
Please Select
Mother
Father
Grandparent
Aunt
Uncle
Sibling
Babysitter/Nanny
Other
Phone Number
*
Please Read our Consent and Release of Liability and Check the box below
Signature of Parent/Legal Guardian
*
Clear
Which event is your student attending?
*
JUN 26-30 YFC CAMP at Crystal Springs $169
JULY 11-15 The Black Hills Adventure $159
JULY 19-22 The Wild West in Medora $179
Scholarships are available. We ask that you pay what you can, and we'll help with the rest, if needed. Please note, you can also give extra to help another student.
*
I will pay full amount
I can pay half, but need help with the balance
I can pay $25.00 but need help with the balance
I will contact YFC office for full scholarship consideration
I will bring a check or cash into YFC
My Payment
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