2024 Hiawatha Youth Camp Registration
We are so excited to have you join us this summer at HYC at Bambi Lake! Please fill out all sections of the form, click submit, and you'll be officially registered for HYC! After submitting your registration, you'll receive an email containing a link to the Hiawatha Paypal payment option. You can pay for your time at HYC online and take advantage of special early registration discount incentives! Please don't hesitate to contact the HYC office with any questions at (734) 284-0200.
Camper Name
*
First Name
Middle Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
Phone Number
*
-
Area Code
Phone Number
E-mail
*
Camper Birthdate
-
Month
-
Day
Year
Date
Camper Gender
Male
Female
Are you coming with a group/ organization?
Yes
No
If yes, what church do you attend?
Who is your Youth Pastor/ Leader?
Emergency Contact Information
Please enter the name of the parent or guardian who should be contacted in the case of an emergency.
Name
*
First Name
Last Name
Relationship to Camper
*
Parent
Grandparent
Legal Guardian
Other
EMERGENCY CONTACT PHONE #1
*
-
Area Code
Phone Number
EMERGENCY CONTACT PHONE #2
-
Area Code
Phone Number
Back
Next
CAMP STUFF
Let us know when you're coming! *Unfortunately, we will not be allowing any campers to stay over between camper weeks this summer. Please plan accordingly.* Please note: if you are registering a student from the UP or are only paying the $50 deposit at this time, please download the registration form on our website and follow instructions there. www.hiawathayouthcamp.com/registration
Choose Your Week(s) at HYC! Note: Teen Week 1 and 3 are SOLD OUT.
prev
next
( X )
July 1 - July 6 | Junior Camp | Rebecca Adkins
$
299.00
July 7 - July 13 | Teen Week 2 | Scott Crownover
$
299.00
Frankenmuth Bible Church Camper
$
299.00
Enter coupon
Apply
Total
$
0.00
If you selected the $50 deposit option, please select which week you are registering for.
Junior Camp
Middle School
Teen Week 1
Teen Week 2
Teen Week 3
Young Adult Retreat
Roomie Request: (Just a request, not a guarantee)
First Name
Last Name
Friend Referral: (Let us know who invited you so we can thank them!)
First Name
Last Name
HYC BUS TRANSPORTATION
Bus transportation is currently not available for this coming summer. Sorry for any inconvenience.
Back
Next
HYC CAMPER MEDICAL INFORMATION
The following information is requested so that Hiawatha Youth Camp can best meet the physical, intellectual and emotional needs that may occur over the course of the summer. Per State of Michigan requirements, please fill out all information requested. Thank you!
Camper Medical History- Any current or previous health conditions? Including:
Allergies (including food and medications)
Asthma
Contacts/Glasses
Dental problems
Diabetes
Diarrhea, constipation, or GI issues
Emotional, social, learning, or other mental health concerns(ADHD, Anxiety, Depression, etc.)
Existing heart condition
Frequent colds, sore throats, ear aches (4 or more per year)
Hard of hearing/deaf
Heart Trouble
Infectious diseases
Issues related to sleep (insomnia, night terrors, bed wetting, etc)
Joint Problems (recent or chronic)
Previous hospitalizations or surgeries
Recent head, back, or neck injury
Seizure disorder
Should activity be restricted because of physical limitation or illness?
Skin Conditions
Special needs or limitations
Any other chronic or recurring illness (not previously listed)
Other concerns not previously listed
Other
Please explain any checked areas from above:
Operations or pre-existing injuries:
Are Camper's immunizations up to date?
*
Yes
No
Recommended treatment by physician:
*
Please list any allergies, including foods or medicines:
If you do not specify the dietary restrictions that are medically necessary, we will not be able to provide special meals.
What reaction happens?
Recommended treatment by physician:
What are your child's medications, including over the counter medications taken on a daily basis?:
***ALL MEDICATIONS SENT WITH YOUR CHILD MUST BE IN THE ORIGINAL CONTAINER.
Please upload a current photo of your child. This is necessary so that in case of an emergency we have a photo to quickly identify your child.
Browse Files
Cancel
of
Back
Next
CAMPER INSURANCE INFORMATION
In Case of an Emergency
Health Insurance Company
*
Policy/ Account #
*
Group #
*
I hereby give permission for routine health care provided by Hiawatha Youth Camp, and in case of emergency, to the licensed physician selected by the camp to hospitalize, secure proper treatment, and authorize anesthesia or surgery for the child named on this form.
*
Yes
No
I hereby give permission to Hiawatha Youth Camp to transport the child named on this form off of the camp premises for purposes of field trip activities.
*
Yes
No
I hereby give permission to Hiawatha Youth Camp to use photos/videos of the child named on this form for the purposes of promoting the camp, and waive all claims to compensation for the use of his/her likeness.
*
Yes
No
Please type name of Parent/ Guardian granting permission.
Back
Next
CAMPER PAYMENT INFORMATION
HYC strives to keep camper costs low so that everyone is able to attend no matter their financial situation. If you have financial need, please contact the HYC office to request financial aid information. When you submit this form, you will be directed to: "http://hiawathayouthcamp.com/payment.htm" From there, you'll be able to officially select your date(s), transportation option, finalize payment, and be officially registered for HYC!
Submit Order
Should be Empty: