• Student Registration

    Please read all information and fill out the form to the best of your ability.
  • Pricing:

    • $325 for early registration if registration is completed by April 30th and $100 deposit is postmarked by May 1st.
    • $350 for registration if registration is completed by May 31st and $100 deposit is postmarked by June 1st.
    • $100 deposit is non-refundable after June 1st.
    • $400 Late registration if registration is completed after June 1st.
    • All payments should come as one check per church.

     

    Please have your church leaders contact Jordan Wright for where to send payment. 

     

    Location of Camp:

    Victory Mountain Wesleyan Camp

    3592 Youth Camp Rd, Sophia, NC 27350

     

    Camp Dates:

    High School June 25-30

    Middle School July 9-14

     

    Questions:

    If you have any questions about camp please reach out to Chris Mikesell at pastorchris@shadygrove.net.

     

     

     

     

  • Student Information


  •  -
  • Emergency / Guardian Contact

  •  -
  •  -
  •  -
  • Media Permission

    Photographs, film, video, or other images may be taken of your student during camp. I consent to the use of my student's image for displays, brochures, videos, and other promotional materials with no compensation to the guardian or student.
  • Clear
  • Medical

    If there is a section that does not apply to your student please leave it blank. It is your responsibility as the guardian to let camp staff know of any medical history that changes between completion of registration and event.

  •  - -
  •  -
  • I, the undersigned parent or guardian of the student I am registering, do hereby authorize NC West Youth district leadership to consent to any emergency examination, x-ray, anesthetic, medical or surgical diagnosis or treatment and hospital care which is rendered under supervision of any physician or surgeon licensed under the provisions of the Medical Practice Act or the medical staff of a licensed hospital, whether such diagnosis or treatment is rendered at the office of said physician or said hospital. Further, as parent or guardian of the student named below, I do consent that my student may receive an emergency medical treatment from any physician, hospital, or other medical center with necessity of first attempting to notify me, the emergency contact, and the youth pastor, and do further agree to hold blameless any physician, hospital or other medical center for rendering such service in the case that the aforementioned contacts cannot be reached.  In addition, I will hold blameless North Carolina West district, Victory Mountain Camp or its leaders and other staff involved.
     

    I also agree (at my own expense) to pick up my child early from camp should any health issue arise.

  • Clear
  • I the above signed parent or guardian; give permission to administer over the counter medications if the nurse deems it necessary. Dosages will be administered according to the directions on the bottle unless a physician directs otherwise.

  • Camp Rules

  • CAMP RULES
    1.   No members of the opposite sex in the same cabin.
    2.   No fighting
    3.    Camp curfew will be abided
    4.    No stealing
    5.    All vehicles will be parked at all times unless they are being used for planned activities (Student keys will be checked in a registration and returned upon leaving
    6.    No vehicles used for transportation around camp
    7.    Students must be present at all scheduled services and events in the designated locations
    8.    No PDA will be allowed
    9.    Modesty is of great importance. Leadership reserves the right to ask you to change and you must comply.
    10.No use of alcohol, tobacco, and illegal drugs.
    11.Students will respect the property and facilities of Victory Mountain, along with the property of NC West Youth and that of other students. Students will be held responsible for any vandalism and destruction.
    12.No weapons of any kind. (Pocket knives and lighters are included).
    13.Although pranks are fun you cannot do anything to anyone’s stuff, or anything that is publicly humiliating.
    14.Electronic devices such as MP3 players, iPods, and cell phones cannot be used during scheduled programming, and may be confiscated if the student if a student does not comply with the rules.

    15. Edibles, Vapes, and CBD (unless prescribed by a doctor) are not permitted.

     

    I agree (at my own expense) to pick up my student early from camp should a disciplinary problem arise. I also understand and agree that I am liable for any and all damages done to any property or belongings which are damaged as a result of my student's actions.

  • Clear
  • Should be Empty: