• Maysville Summer Youth Camp 2026 ADULT Registration June 22-26, 2026 Location: Maysville Wesleyan Campgrounds, 8682 Mason-Lewis Rd, Maysville, KY

    This form is for director-approved workers and adults.

  • ADULTS/STAFF NOTE: All information is kept confidential and is only available to camp administrators and, if necessary, medical providers.

  • COST $100.00 per staff member (staff must be pre-approved by the director). Make checks payable to Maysville Wesleyan Youth Camp. Mail checks to Michael Schwind, 9611 Harrodsburg Rd, Wilmore, KY 40390.

  • *Please fill out this form in entirety for each staff member.*

  • Format: (000) 000-0000.
  • Gender*

  • Family Information

  • Format: (000) 000-0000.

  • Health Insurance / Physician Info

    Please provide as much information as possible.
  • Format: (000) 000-0000.

  • Medical Info / Release Form

    The medical questions below serve as the camper's medical release form. Campers and parents must complete the form for each participant in order to attend Maysville Wesleyan Youth Camp.
  • Allergies:
  • Diet / Nutrition:

  • Emergency Authorization: I hereby give permission to medical personnel selected by the participant's Church sponsor/his designee or camp staff to order X-rays, routine tests, and treatment for myself. In the event of an emergency and neither my primary contact nor secondary can be reached, I hereby give permission to the physician selected by the Authorized Agent to hospitalize, secure proper treatment, order injections and/or anesthesia and/or surgery to myself as named above. I further authorize the release of the above medical information to appropriate medical personnel and/or the health coverage insurance company. In addition, I have, and do hereby, release the church, its employees or agents from liability associated with participation in a church activity. I understand that if I do not have medical insurance, I will be responsible for any medical expenses in the event of a sickness and/or injury.  I understand that there are risks involved in taking place in recreation activities and other activities related to participation in youth functions.

    Photo Release: With participation, I give permission for myself to be photographed, and/or videotaped while participating in the above stated camp/retreat for the purposes of publicity, staff training, and/or promotion.

  • I certify that the information described above is accurate and complete to the best of my knowledge. 

  • Should be Empty: