LYC 2025 CAMPERS

LYC 2025 - June 19-23

LAKE LAVON CAMP & CONFERENCE CENTER 8050 County Road 735, Princeton, TX 75407
Welcome to Liberty Youth Camp where sharing the gospel and having a week full of fabulous memories go hand in hand.

Liberty Youth Camp welcomes campers ages 4th – 12th grade. If your child has graduated from High School they are no longer considered a camper. Please have them complete a staff application.

$350 1st Camper, $300 2nd Camper

Deadline for all applications is April 15th, applications are handled on a first come first serve basis.

Please submit Application along with the Registration Fee

DROP OFF Thursday, June 19th @ 4:00pm

PICK UP Monday, June 23rd @ 10am

Lake Lavon Confrence Center
8050 County Rd. 735, Princeton, TX 75407
Camper Information
Spring Valley Bible - Liberty Youth Ministry
CAMPERS NAME*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState Abbreviation

Zip Code
Campers E-mail
example@example.com
Campers Cell #*

Area CodePhone Number
Gender*

FemaleMale
Age*
Ages 8 - 18
Date of Birth*

MonthDayYear
11th -12th Graders as of Fall 2025, Please check Yes, If your are interested in becoming a Junior Counselor. An interview will be required.

Yes I am interested in becoming a Jr Counselor
Next Year School Grade*
Going into NEXT YEAR
T-Shirt Size*
Have you attended LYC Camp in the past?*

YESNO
If you have NOT attended camp kindly share who referred you
Parent Information
Parent / Guardian Name *

First NameLast Name
Relation to Camper*
Relative or Friend
Cell Number*

Area CodeCell Number
Parent Email *
example@example.com

Medical Information
Family Physician's Name: (If you do not have one please note NONE)*
Physicians Phone Number

Area CodePhone Number
Is the participant covered by medical / hospital insurance?*

YESNo
If so, indicate carrier or plan name
Policy or Group #
Member Services Phone

Area CodePhone Number
Age*
Ages 8 - 18
Height*
Ex 5.4 use decimal
Weight*
Ex: in pounds
Non Food Allergies
Food Allergies
List recent illnesses, injuries and hospitalizations relevant to above physician
Medications Being Taken: Please list all medications (including over the counter or non prescription drugs) Bring enough medication to last the entire time at camp. Keep it in the original packaging / bottle that identifies the prescribing physician, name of the medication, the dosage, and frequency of administration.*

NOYES - Please list below
Current Medications, Dosage, Times, Instructions
List each Med / dosage/ frequency / times by Line

Medical Legal
Is your Childs immunizations records up to date?*

Yes we are up to dateNo, I am exempt
Allergic to Tetanus Booster? *
Select from drop down
Date of last Tetanus Shot if applicable

MonthDayYear
I, give permission to Lake Lavon Camp and Conference Center’s management, medical staff, LYC Camp Nurse, or Camp Leadership and/or the group director to provide medical treatment that may be deemed necessary to insure the well-being of the named student. I, the undersigned do hereby verify that the above information is correct and I do release and forever discharge all from any and all claims, demands, actions or cause of action arising out of damage or injury while participating in Lake Lavon Camp sponsored activities. I understand my personal insurance coverage will be Primary Coverage.
(Please initial below) *
Emergency medical decision, Please Initial*
I hereby authorize LYC Camp Nurse, to dispense over the counter medications as deemed necessary without my notification.

Please check yes or no below
OTC Meds*

YES, I give my permissionNO, Contact me first
ALL MEDICATIONS must be given to the Camp Nurse.
Place medications in a large Ziploc bag labeled with your child's name and LYC.
Prescriptions must be in the original container with the camper's name and current dosage clearly marked.
No medications will be given unless they are in original containers per Texas Department of State Health Services. If your child/youth requires an asthma inhaler or antidote for insect bite or allergies (prescribed by doctor) The medication must be registered with the Camp Nurse. If camper needs to hold inhaler, special cases must be discussed with the Camp Nurse.

By signing this document, you give permission for your child/youth to be inspected for head/lice eggs, if the need arises. You understand that any such check would be conducted sensitively. You understand Lake Lavon Camp's Notice of Privacy Practices will use and disclose health information about your child/youth to group leaders, the child's sponsor, and designees, and any medical staff, when in its sole discretion believes such communication to be in the best interest of your child for treatment.

Emergency Contact
If parent / guardian cannot be reached in an emergency, please contact: *

First NameLast Name
Phone / Cell #*

Area CodePhone Number
Relationship To Camper*
CAMPER PICK-UP POLICY: Remember that the continuity of the camp experience is used by the Holy Spirit to touch camper's hearts. Taking a camper out for even a brief period can reduce the spiritual effectiveness of camp. Please minimize absences. Written permission must be provided to the camp before a child will be allowed to leave with any person other than those listed below:
Name

First NameLast Name
Frequency of Camper Pick-Up
Name

First NameLast Name
Frequency of Camper Pick-Up

Signature Page

Assumption of Risk Release of Liability
ASSUMPTION OF RISK AND RELEASE OF LIABILITY
Definitions:
“CAMP” means LIBERTY YOUTH MINISTRIES (LYM) & LIBERTY YOUTH CAMP (LYC) and/or LAKE LAVON CAMP & CONFERENCE CENTER and/or LAKE LAVON BAPTIST ENCAMPMENT, a Texas non-profit corporation, its Member Churches, Directors, Officers, Employees,
Agents, Volunteers, or Associates.

Lake Lavon Camp & Conference Center, hereinafter referred to as the "Camp" requires a signature for all attendees of the Camp and all participants of any Camp activity including, but not limited to, Challenge/Ropes Course (highs and lows), Warped Wall, Swimming Pool, Camping, Basketball, Football, Baseball, Softball, Volleyball, Nerf Battle, Horseshoes, Archery, Archery Tag, Rifle Range, Disc Golf, GaGa Ball, Bazooka Ball and any and all other camp and recreational sports and activities. Furthermore, this form releases the Camp to photograph and/or use photographs of myself or my child for use in its publications, advertising, promotional purposes, Internet, and/or visual presentations which inform people of the services and activities of Camp.

The signature provided confirms Agreement to Attend, Participate, Assumption of Risk, and Release Form in order to attend Camp and to participate in any Camp activity. Attendance and Activities at Camp may include warms-ups, games, group initiative problems, high and low challenge course, and/or other rigorous physical adventure activities as well as exposure to the elements, exposure to animals, snakes and insects. Camp takes all reasonable precautions to ensure you a safe and enjoyable experience. Parts of the experience, by their nature, can be physically demanding and include varying levels of stress and anxiety, not all of which can be foreseen. The decision to attend the Camp and the decision to participate in any Camp activity at any level IS AT ALL TIMES COMPLETELY UP TO THE INDIVIDUAL'S CHOICE and, if there is attendance at the Camp and participation at any level of any Camp activity, there is a risk, which must be assumed by each attendee and by each participant. Although it is the Camp's goal to maintain the physical, emotional and social safety of each attendee and participant of the Camp, the physical, emotional and social risks must be assumed by each attendee and participant.

"I understand that attendance at the Camp and participation in any Camp activity may be physically and emotionally demanding. I recognize the inherent risk of physical and/or emotional injury of attending Camp and participating in any and/or all Camp activities. I understand that each participant must assume the risk of any injury, physical and/or emotional, and any financial responsibility that could result from attending Camp and participating in any Camp Activity. I agree to assume such risks and such responsibility. I, on my behalf, and on behalf of my heirs and assigns, hereby release, indemnify and hold harmless Lake Lavon Camp and Conference Center from any and all claims, physical and emotional, including bodily injury, that I may have that may be sustained in connection with my attending Camp and with my participation in any and/or all Camp activities."

If you feel that there are any activities in which you or your child should not be involved in, please describe for us on an attached sheet the activities (include name and church/group name on the attached sheet). I understand the directors of Lake Lavon Camp and Conference Center reserve the right to dismiss, without refund, any camper whose influence is detrimental to the operation of the camp, as determined by the discretion of the directors. I understand that the use of alcohol, tobacco products, and illegal drugs is strictly prohibited at all Lake Lavon Camp and Conference Center programs.

I have read (or had read to me) this complete document and I understand the information contained herein. I have freely and voluntarily signed this document.

SAFETY: Applicant will wear shoes and socks and bring and apply sunscreen as necessary. Applicants who are minors or with youth groups will not leave the CAMP grounds, authorized areas, or vehicles transporting Applicant at any time without permission, and Applicant agrees that CAMP is not responsible if Applicant violates this rule. Applicant agrees to follow all safety instructions and to use caution to protect Applicant, other camper, CAMP personnel, and others. Applicant understands that failure to obey safety rules will cause
expulsion from CAMP

Camper Statement: I agree to obey all rules (rules having to do with safety and Christian behavior) and regulations of Lake Lavon Camp & Conference Center, and will cooperate with leaders and fellow campers and
with the camp staff at Lake Lavon Camp.
I have read the Risk and Release of Liability: Name of Attendee*

First NameLast Name
Camper please initial*
MUST INITIAL
**The assumption of Risk and Release of Liability acknowledgement above is applicable to all Directors, Officers, agents and volunteers from Spring Valley Bible Church hosting this event**
PARENT or CONSERVATOR: BY TYPING IN MY NAME AND INITIALING BELOW, I VERIFY THAT I HAVE READ AND UNDERSTAND EVERY PROVISION OF THIS AGREEMENT*

First NameLast Name
INITIAL *
MUST INITIAL
Signed this day*
REPRODUCED IMAGES
LLCCC & LYC has permission to use any photographs/videos of person listed on this form for brochures, videos, advertising, web page or other promotional items. I/we further understand that these photos/videos will only be used for LLCCC promotional purposes.
COVID-19 Protocol
- Extensive staff training.
- Daily health checks of staff.
- Restricted access to facilities.
- Lower number of guests at one time.
- Additional handwashing stations and hand sanitizer throughout facilities.
- All areas cleaned and disinfected with hospital grade products.
- Meeting areas treated overnight with an ozone generator.
- Meals served by staff.
- Ample space for appropriate distancing.
We are adhering to the guidelines set forth by the State of Texas and Collin County authorities in association with The American Pediatric Association and the Center for Disease Control.

If you are planning to attend an event at our facility, we require that you confirm that you;

-Do not have the following symptoms-
Cough, Shortness of breath or difficulty breathing, Fever, Chills, Muscle pain, Sore throat, New loss of taste or smell, Nausea, Vomiting, Diarrhea.

-Have not been in recent contact with anyone with these symptoms.

-No one in your household has been sick in the last 14 days.

Everyone attending Lake Lavon Camp should understand that attending camp includes a certain amount of inherent risk and that it is a choice to attend. We at Lake Lavon Camp take every guests wellbeing very seriously. We are following the protocols set forth by the State of Texas and the CDC.
Initial here that you have read and understand the Lake Lavon Camp COVID-19 Protocols (Parent/Guardian initials if attendee is under the age of 18)
LAKE LAVON CAMP POLICIES

1.     Prank supplies are not allowed (i.e. Shaving cream, water balloons, spray paint, water guns/blasters, silly string) in the buildings. Please request Lake Lavon approval for use of these supplies outdoors.

2.     Adult supervision is required at the pool/Swim Lake/ Lake Front/Ropes Course/Warrior Course etc. At no time is a student to go to these areas without adult supervision.

3.     Drugs, alcohol, any form of tobacco, firearms, knives, or any other kind of weapon, or fireworks are NOT allowed.

4. Appropriate Godly dress attire is expected. Casual clothing is acceptable during all activities. Shorts (for boys and girls), skirts and skorts (for girls) should be no shorter than fingertip length. One piece modest swimsuits are requested. Swimsuits should only be worn at the swimming pool. Shoes are required to and from every activity.

5.     Please refrain from Public Display of Affection (PDA) with girlfriends/boyfriends.

6.     No fighting, physical aggression or bullying will be tolerated.

7.     All snack items must be stored in sealable containers to prevent ants and other insects in the dorms and meeting rooms. Texas Department of Health regulations prohibit cooking in dorms without kitchens.

8.     Guests are not allowed to bring pets on campus. No pets in the dorms, conference center or meeting rooms.

9.     Students are to respect all adult leaders and follow their instructions.

10.    Any graffiti clean-up costs will be charged to the responsible parties.
NOTE FOR MULTIPLE CAMPERS: It is important to follow these instructions closely.

You must do an application for each camper, then submit payment for each application.

1. For the 1st Application, Click 1 Camper, Submit AND PAY the $350.00 fee
2. For the 2nd Application, Click the 2 Camper, Submit AND PAY the $300.00.
3. For the 3rd Application, Click the 3 Camper, submit AND PAY the $300.00

In total you will pay 1 camper $350.00, 2 Campers a total of $650.00 and 3 campers $950.00
*
prevnext( X )
LYC CAMPER #1$350.00
1st Camper Fee

LYC CAMPER #2$300.00
2nd Camper Fee

LYC CAMPER #3$300.00
3rd Camper Fee

Total $0.00
Should be Empty:

LYC 2025 - June 19-23

Camper Information

Parent Information

Medical Information

Medical Legal

Emergency Contact

Signature Page