2025 Backyard Mission Camp Registration

Backyard Mission Camp 2025will run from Wednesday, June 25 - Sunday, June 29. We welcome students who are rising 6th - 12th graders to serve right here in your own community.

You do not have to be a member of a church, a devout Christian or even religious to be part of Backyard. We do ask that you are open to being part of a faith-based community rooted in scripture and the teachings of Jesus.

By registering you are promising to be respectful to others and to participate in activities to the best of your abilities. You are signing up to be part of a team made up of people with different gifts, points of view and experiences.

While we do hope everyone will pitch tents and stay at camp for the duration, we understand things come up and it's not for everyone. We ask you to give it a try before making a decision. We have tents available for anyone who needs one but camping is completely optional.

We're thrilled you're going to be part of Backyard and we can't wait to do good stuff together!

Direct your questions to

Jen Hedrick (Backyard Squad Leader)

jenhedrick0313@gmail.com

704.932.9328

If you are an adult who will be volunteering with Backyard and working with students, we need your info as well. Please complete a separate form for each participant.

Camper Name

First NameLast Name

DOB

Date

Age

Grade you are entering this Fall

Phone Number 1

Phone Number 2

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

T-Shirt Size

Will you plan to camp overnight?

Do you need a tent?

YesNo

Is there anything we need to be aware of concerning behaviors, ability, limitations, etc?

Do we have permission to use photos/videos of your child(ren) in promotional materials like website, social media or printed medium?*

YESNO

Parent/Guardian Information

Name

First NameLast Name

Relationship

Phone #

E-mail

example@example.com

Name

First NameLast Name

Relationship

Phone #

E-mail

example@example.com

MEDICAL & EMERGENCY CONTACT INFO

Emergency Contact's Name*

First NameLast Name

Relationship

Phone Number

Alt. Phone Number

Please list any allergies, chronic illness, or medical conditions

List current prescription & over-the-counter medications

Insurance Provider

Insurance Provider Phone #

Insurance policy ID#

Primary Account Holder Name

Primary Account Holder DOB

MonthDayYear

Birth Date

MonthDayYear

Camper fee is $100. This covers things like food, operating expenses, camp supplies, t-shirt, fuel, etc.

We don't want Backyard to be cost-prohibitive for anyone. We understand expenses add up, especially if you have more than one child. We're happy to work with you to provide assistance or work out an installment plan. Just let us know.

Payments are due by JUNE 20.

PAYMENT OPTIONS:

PAY ONLINE

When you click "REGISTER" button, you'll automatically be re-directed to our online giving platform. In the dropdown menu for "FUNDS" - select "MISSIONS" to choose options and set up your payment.

SCAN QR CODE

QR code will direct you to our online giving platform. In the dropdown menu for "FUNDS" - select "MISSIONS" to choose options and set up your payment.

MAIL or IN-PERSON

Checks made payable to Epworth UMC (memo BACKYARD)

1030 Burrage Rd NE . Concord, NC . 28025

ATTN: Jen Hedrick

Informed Consent and Acknowledgement

EPWORTH UNITED METHODIST CHURCH

1030 BURRAGE RD NE . CONCORD, NC 28025

704.786.6183 . EPWORTHNC.COM

I agree for my child(ren) to participate in the activities of Backyard Mission Camp under the supervision and guidance of adult volunteers who will adhere to the guidelines of Epworth's Safe Sanctuary policy.

To ensure volunteers and camp organizers are able to care and respond to my child(ren) should a situation arise, the information I've provided is up to date and accurate.

I willingly and knowingly assume for myself, my heirs, family members, executors, administrations and assign all risk of physical injury and sickness and emotional upset which may occur during camp and hereby agree to hold Epworth United Methodist Church, Inc., its employees, members, or trustees harmless for any liability arising out of my child(ren)'s participation in the event. I hereby give permission for photographs taken of my child/me during this event to be used in camp and/or church publicity, reports and recruitment (UNLESS OTHERWISE STATED ABOVE).

I have read, or have had read to me, all information regarding the camp my child is attending at Epworth United Methodist Church, Inc. including policies, procedures, limitations, and possibilities. My child, as named above, has permission to participate fully in all camp activities.

Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

Signature*

June 25 - 29

Camper Registration

Camp Fees