Florida CHC Youth Camp 2024
Camper Registration (Please complete one per camper)
Junior Camp Dates: June 21- 24 Senior Camp Dates: June 25-28
Name of Camper
*
First Name
Last Name
Camper Grade for upcoming school year:
*
Camper Age
*
Camper Birth Date
*
Please select a month
January
February
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Month
Please select a day
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Day
Please select a year
2024
2023
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Camper is:
*
Male
Female
Name of parent/guardian
*
First Name
Last Name
Email of Parent/Guardian (Please use the same email that you will include on your tithe.ly payment if using that online paying option)
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number of Parent/Guardian
*
Please enter a valid phone number.
Additional Phone Number
*
Please enter a valid phone number.
Home Church and Pastor
*
Home church
Pastor Name
Select Which Camp you are registering for:
*
Junior Camp Day Camper ages 4- 7
Junior Camp ages 8-12
Senior Camp ages 12-19
T-Shirt (Free if registered by May 26th) After May 26th availability may be limited. And shirts cost $10
*
Please Select
YXS 4-5
YS 6-8
YM 8-10
YL- 10-12
YXL- 12-14
Adult Small
Adult Medium
Adult Large
Adult XL
Adult 2X Large
Adult 3X Large
Adult 4 X Large
Camper Name for T-shirt
blanks
*
Home Church
blank
*
Payment Method for t-shirt.
Please Select
Free for early enrollment
Tithe.ly online
Cash
Check
Amount Paid for T-Shirt (if applicable)
$10 for sizes Youth XS through Adult XL
$12.50 for sizes Adult 2x through 4x
Concession Tab
This section is only if you would like to prepay for concession tabs. You may also choose to put money on the tab when they arrive at camp. You may pay by cash, check, or online via tithe.ly app.
I would like to prepay concessions for: (optional)
Junior Camp
Senior Camp
I will prepay concessions by: (optional)
Cash
Check
tithe.ly app online
Please type in the amount of money you are going to prepay on tab. (If planning to)
My child has the following allergies or foods they need to avoid: Please put N/A if there are no allergies or food restrictions. Please include any special directions or limitations if applicable.
*
Please list any food restrictions or allergies in detail.
Payment Information
Make Checks payable to Florida Youth Fund. CHC Florida Camp: Campers must submit a registration form and at least a $40.00 deposit on or before due date of May26th to receive the free t-shirt. Each family member attending Youth Camp must fill out a separate form. Camp fee $80.00 for All CH Church: Camp fee for the first child is $80.00. For additional children in the same household the fee will be $75.00 per child. ALL NON-Congregational Holiness Church: Camp fee for the first child is $90.00. For additional children in the same household the fee will be $85.00 per child. If paying online via tithe.ly then submit this form, and pay online. You will be directed to tithe.ly for online payment at completion of this form. On tithe.ly please include camper names in the memo when you pay. You may pay for multiple children at one time on tithe.ly but please include each camper name in the memo, and fill out a registration form for each child. If you are paying with cash or check please send payment to: Evelyn Scerbo, 215 SE Doppler Ct, Lake City, FL 32025 For more information please email: FloridaCHYouthCamp@gmail.com or call the Youth Camp Director: Rebecca Crews (386) 965-9731
Total amount of payment submitted with this form
*
Please include any payment for registration, t-shirts, or concession stand tabs. If paying via tithe.ly you will be directed to the website at completion of this form.
My Payment Includes: PLEASE SELECT ALL THAT APPLY
*
Full Registration Cost
Early Registration Deposit of $40
Concession Tab PrePay
T Shirt Payment (if after May 26th)
Payment made via:
*
Check
Cash
Tithely. app online
You will be directed to the tithe.ly website at completion of this form to make payment online for those who choose to pay online. IF YOU ARE NOT PLANNING TO PAY WITH TITHE.LY YOU CAN CLOSE THAT WINDOW WHEN IT OPENS.
Baptism
Baptism: Please sign here ONLY IF YOUR CHILD CAN NOT BE BAPTISED. Your signature will indicate that you DO NOT want your child being baptized at youth camp.
Medical Information
List any chronic or recurring illness, allergies or any special care or medication normally given. Notify the camp director if this camper has been exposed to any communicable diseases during the 3 weeks prior to camp attendance.
Sign ONLY if your child CANNOT be given medication for a headache, upset stomach,etc. without calling Parent/Guardian.
Phone number to contact parent for permission to give meds if signed above that medication can not be given without calling.
Please enter a valid phone number.
Is camper in good health?
Yes
No
Has camper had operation or serious surgery?
Yes
No
Is there a reason that your child can not participate in any activities? If so please list.
Agreement
As a camper: I am aware of the camp policies and guidelines. I understand that this is a church camp and that certain standards of conduct will be required of me. I agree to abide by the camp rules and to demonstrate respect for the camp staff at all times. I understand that if I fail to keep my agreement, I may be asked to leave camp. I give permission to use pictures in which I may appear in camp brochures, flyers, or other promotional literature; both electronic and published that is used by the camp. As a parent/guardian: I have read the Camp Policies and Guidelines and reviewed them with my child. I accept them and expect my child to abide by them. I will be responsible for any and all property damage by my child when he/she is at camp. In case of a simple accident or illness, I hereby release the aforementioned Youth Camp Leaders from all responsibilities relating to the administration of that care. I hereby authorize any use full information to aid in treatment (blood type, special drugs, and medications) for said child. I request the Camp Director or staff to contact me immediately. I give permission to use pictures in which my child (as a camper) may appear in camp brochures, flyers, or other promotional literature; both electronic and published that is used by the camp. I have been informed that during camp, my child will participate in activities that could include transportation to/from camp.
Be sure to read the rules and regulations of camp before signing and submitting the application. It may be difficult to read in this browser, but you can also download or print to see in full size.
Parent/Guardian Signature
*
Camper Signature
*
Date
*
-
Month
-
Day
Year
Date
Pastor's Name
First Name
Last Name
Submit
Should be Empty: