Press Pause: Registration for CCYC2024

Press Pause: Registration for CCYC2024

We are so excited to have you for CCYC this year! The dates are July 8th-12th, 2024. Registration is $100 (through June 14th) and $125 (after June 14th). Please take a moment to fill out the registration form. We'll see you in July!
Camper Information
First Name*
Last Name*
Gender*

FemaleMale
Date of Birth (ages 12-20)*

MonthDayYear
Date
Age at Time of Camp*
Cell Phone Number
Please enter a valid phone number.
Email Address
example@example.com
Camper's Pastor Name
Lodging Preference: If desired, list up to two people you would prefer to room with during camp.

Emergency Contact & Camper Medical Information
Emergency Contact Name*

First NameLast Name
Emergency Contact Number*
Please enter a valid phone number.
Emergency Contact Email*
example@example.com
Relation to Camper*
Camper Allergies*
If there are not any allergies, please indicate as such: N/A
Camper's Insurance Company*

Cell Phone Policy

All campers need to read through the CCYC Cell Phone Policy and agree to follow the policy by signing below, after reading each item below. Please note, emergency camp contacts are Charles Holden: (317) 402-7837 and Kristen Holden: (317) 460-5989.
I, Camper Full Name* and Parent/Guardian Full Name*, confirm that I have read the above cell phone policy and agree to follow the policy during CCYC. I also am aware that CCYC is not responsible for cell phones if they are lost, stolen or broken.
Camper Signature*

Clear
Parent/Guardian Signature*

Clear

Parent/Guardian Consent

Read the below statement and sign.
I, Parent/Guardian Full Name*, confirm that I am the legal guardian of Camper Full Name* . I agree that my child will be picked up by 2 pm on Friday, July 12th and will not be dropped off earlier than 12 pm on Monday, July 8th, unless coordinated otherwise. If I am needed, I can be reached at Phone Number*.
Parent/Guardian Signature*

Clear

Additional Information

Please check the box to signify you have read each item.

Payment

In addition to registration, we have included several other options to be purchased ahead of time. Please take a moment to read each description. You can pay in person at the time of camp, but we encourage you to pay online ahead of time. If you plan to be in person or would prefer receiving an invoice to pay later, use the promo code INVOICE before checkout.

Registration Options

2024 CCYC ShirtWe are excited to offer a brand new shirt this year! The purchase of a this year's shirt includes a vintage CCYC shirt of the same size, as available. Vintage shirts are on a first-come basis.

$20.00 Sleeve LengthSize

Snack Store VoucherSimplify your child's camp expenses with our snack store vouchers. Each $10 voucher equals $10 to spend at the snack store. Adjust the quantity for higher amounts, if needed.

$10.00 Quantity

Camper Scholarship FundCCYC offers a scholarship to campers who are needing extra help in making it to camp. It is our belief that everyone should have the chance to come to youth camp. Should you choose to give, this money will go towards the scholarship fund.

$10.00 Quantity

RegistrationCamper registration fee helps cover some of the cost of youth camp.

$125.00

Enter coupon

Total

$0.00

Payment Methods

Debit or Credit Card

Please click one of the PayPal options to complete payment and submit the form.

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Press Pause: Registration for CCYC2024

Camper Information

Emergency Contact & Camper Medical Information

Cell Phone Policy

Parent/Guardian Consent

Additional Information

Payment