Northgate Youth Camp 2023

Northgate Youth Camp 2023

To whom it may concern,

This form is for Northgate Youth’s summer camp in 2023. Northgate Youth Camp is a summer camp run by Northgate Church for students going into grade 6 in Fall 2023 up to high school graduates of 2023. At Northgate Youth Camp, your child will participate in various activities that include, but are not limited to: chapel sessions, field games, meal times, paintballing, and more. See below for the information we will be needing from you in order to establish consent for your child to participate in Northgate Youth Camp this year.

WHAT: Northgate Youth Camp 2023

WHERE: Selah Campsite (3539 Cessford Rd, Courtenay, BC) and the Puntledge River.

WHEN: August 8-12, 2023, day camps*

DROP OFF & PICK-UP TIMES: Detailed daily schedule will come to website soon*

More details on website

	Tuesday	Wednesday	Thursday	Friday	Saturday
Drop-off	1:00PM	10:30AM	10:30AM	10:30AM	10:30AM
Pick-up	9:00PM	9:00PM	9:00PM	9:00PM	5:30PM

Number Of Youth Registering*
Up to 3 youth at a time.

Youth 1 Section
Youth 1
Name*

First NameLast Name
Birthdate*

MonthDayYear
Date
Grade*
Grade in Fall 2023
Medical Care Card #
Optional
Medical Concerns, Allergies, and Food Preferences.
Lunch & Dinner Will Be Provided

Youth 2 Section
Youth 2
Name*

First NameLast Name
Birthdate*

MonthDayYear
Date
Grade*
Grade in Fall 2023
Medical Care Card #
Optional
Medical Concerns, Allergies, and Food Preferences.
Lunch & Dinner Will Be Provided

Youth 3 Section
Youth 3
Name*

First NameLast Name
Birthdate*

MonthDayYear
Date
Grade*
Grade in Fall 2023
Medical Care Card #
Optional
Medical Concerns, Allergies, and Food Preferences.
Food Will Be Provided

End of Youth Info
Address*

Street Address

Street Address Line 2

CityProvince (Ex. BC)

Zip Code
Contact Info

Parent/Guardian
Primary Contact Name*
First And Last Name
Primary Contact Number*
Phone Number
Primary Contact Email*
This will be our main channel of communication.
Secondary Contact Name*
First And Last Name
Secondary Contact Number*
Phone Number

Youth Code of Conduct & Rules
Parents, we’re excited to host your youth for NYC 23! In order to help everyone have a safe and fun experience, please make sure you show this document to your youth so they understand what is expected of them at NYC 23.

CODE OF CONDUCT
While attending NYC 23, I will respect:
- PEOPLE — I can honor God with how I treat others. I’ll show respect to everyone around me, including staff, leaders, volunteers, and other youth. This includes what I do and what I say. I’ll listen when others are speaking, and I’ll show gratitude for what others do for me.
- PROPERTY — Being allowed to use what belongs to others is a privilege. I’ll take care of all facilities, vehicles, and properties. I will leave every location better than I found it.
- MYSELF — I am responsible for the decisions I make. I’ll be a positive role model to others around me, obey all rules and instructions, and make wise choices.
While attending NYC 23, I won’t be:
- A BULLY — Being mean or hurtful to others is wrong — everyone should feel safe and welcome wherever I am. I won’t intimidate anyone, hurt anyone through my actions or words, be aggressive or violent, or make anyone feel left out. If I see bullying, I’ll report it a leader immediately.
- NEGATIVE — Our words should be used to build others up — not tear them down. I won’t gossip or talk about other people in a mean way, or say anything that could hurt someone.
- CARELESS — Going to camp and doing activities is fun, but it comes with responsibility. I’ll make sure I don’t put myself or others in danger, or take risks that could get someone hurt.
RULES

Parents/Guardian, if your youth breaks any of these rules, you may be called to pick him/her up from wherever he/she is at that time. There will be no refunds if this happens.
- Listen — Obey leaders and staff at all times.
- Bullying — Bullying will not be tolerated. This includes any attempt to harm, intimidate, isolate, or force someone to do something.
- Substances — No drugs, alcohol or any other illegal substances.
- Clothing — No inappropriate clothing. This includes revealing clothing and clothing with logos, phrases, or graphics that contain profanity or sexual/offensive content.
- Weapons — No weapons (including pocket knives) are permitted.
- Contact — No inappropriate contact with other youth. This includes any public or private display of romantic affection.
- Behavior — Stealing, lying, fighting, and other disruptive behavior will not be tolerated.
YOUTH: By attending camp, you will be informed of the NYC 23 Code of Conduct and Rules and you acknowledge to understand the NYC 23 Code of Conduct and Rules. If you break any of these rules, a parent or guardian will be called to pick you up, and you will not attend the rest of NYC 23.

PARENTS: By signing this form, you acknowledge that your youth understands the NYC 23 Code of Conduct and Rules, and that you are responsible for picking him/her up if any rules are broken.
Liability Waiver & Parent/Guardian Sign
As the parent/guardian of the above-mentioned student(s), I hereby grant permission for him/her to participate in Northgate Youth Camp 2023. I release Northgate Foursquare Church, its volunteers, staff, and offsite hosts from all claims resulting in illness, injuries, or other damages to property or persons, which may be sustained by him/her during their participation at Northgate Youth Camp 2023. In the event of illness or injury, I hereby authorize leaders of the church to provide or obtain appropriate medical assistance and treatment for the above student. Should the student(s) choose to act inappropriately over the course of the events, the church holds the right to have the student sent home.
IF YOU DO NOT consent to photos/videos to be taken of your child for church sharing purposes, please state here:
Parent/Guardian Name*
Parent/Guardian Signature*

Clear
Date*

MonthDayYear
Date

Payment

Please refer to the website for the refund policy.
Please choose your payment method.*

PAY IN PERSON - If you are paying in person, we can receive cash, debit/credit, and cheque. (Cheque payable to Northgate Foursquare Church, memo line: NYC 23 & Youth Name)ONLINE PAYMENT - Please select the option below if you are paying via online.

Please select and choose quantity according to number of students registering

NYC 23 | Early Bird PricingFirst 15 Signups

$150CAD Quantity

NYC 23 | Regular PricingFebruary 1-June 30th, 2023

$200CAD Quantity

NYC 23 | Non-refundable depositPay $50 now, and pay $150 by July 1st, 2023(For Regular Pricing)

$50CAD Quantity

Enter coupon

Total

$0.00CAD

Credit/Debit Card

Questions/Comments
Do you have any questions or comments for us?
Should be Empty:

Northgate Youth Camp 2023

Youth 1

Youth 2

Youth 3

Contact Info

Youth Code of Conduct & Rules

Liability Waiver & Parent/Guardian Sign

Payment

Credit/Debit Card

Questions/Comments