2025 M.S. Winter Camp Registration
February 7-8 | Join us for Kimball Camp in Reading, MI
PARTICIPANT INFORMATION:
Participant Name
*
First Name
Last Name
Participant Phone Number
*
Participant Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Birth Date
*
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
Please select a year
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Gender (for housing considerations only)
*
Male
Female
Participant School
*
Grade
*
6
7
8
List anyone specific you would like to room with
We cannot guarantee you'll be with requests, but we will do our best.
Back
Next
PARENT/GUARDIAN INFORMATION:
Parent/Guardian Name
*
First Name
Last Name
Address (if different than student address)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
E-mail
*
example@example.com
SECONDARY EMERGENCY CONTACT:
Secondary Emergency Contact
*
First Name
Last Name
Phone Number
*
AUTHORIZED PICKUP PERSON(S):
If different than the names listed above.
Authorized Pickup Person(s)
First Name
Last Name
Authorized Pickup Person(s) Phone Number
Back
Next
MEDICAL INFORMATION
**If you do not have a physician or medical insurance, please put N/A in the spaces provided.**
Physician Name
*
First Name
Last Name
Physician Phone Number
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Has the participant had a physical within the last 24 months?
*
Yes
No
Medical Insurance Company
*
Policy Number
*
Allergies - check those that apply and specify nature of allergic reaction:
*
None
Animals
Environmental
Medication
Food
Insects
Latex
Other
Non-Prescription Medications:
The following non-prescription medications may be used on an AS NEEDED BASIS to manage illness and injury. Please indicate below which medications the participant may NOT receive. These non-prescription medications will be administered by YFC staff according to manufacturer's labeled dosages unless a written statement (prescription) from participant's health-care provider authorizes a different dosage.
Check the medications a camper should NOT have:
*
All of these options are ok for the participant to have as needed
Acetaminophen (i.e. Tylenol)
Aloe Vera Gel
Antacid (i.e. Tums)
Antiseptic Wipes (Benzalkonium Chloride)
Bacitracin/Triple Antibiotic Ointment
Calamine Lotion
Diphenhydramine oral tablet (i.e. Benadryl)
Cough Drops
Hydrocortisone 1%/Anti-Itch Cream (i.e. Benadryl cream)
Ibuprofen (i.e. Advil)
Loperamide HCI (i.e. Imodium AD)
Loratidine (i.e. Claritin)
Menstrual Relief (i.e. Midol)
Sunscreen Lotion
Vosol Ear Drop (i.e. Swim Ear)
Medication Administration Instructions:
"If medicine is present during YFC activities, that medicine must have written instructions present with it during the activity from a doctor, parent, or legal guardian." Any medication, prescription or over-the-counter, brought to an YFC activity must have written medical instructions and dosage information from a physician, parent or legal guardian. All medications must be in the original container where issued.
List the name of medications, time of day for administering, things to consider for administering:
Please use this space to describe all details of dosing and administering of the prescription, non-prescription medications, and nutritional supplements participant is bringing with them, as well as any drug interactions that you are aware of with these medications prescriptions.
Medical Concerns
Please provide any additional information about your participant's health that you think important or that may affect their ability to participate in YFC activities.
Back
Next
LIABILITY RELEASES
These releases MUST be completed by the parent/guardian of the participant, unless the participant is 18 years of age or older.
YFC Consent and Release of Liability: I represent that I am the participant named (if 18 or over) or the legal parent/guardian of the child named, who is under 18 years of age. In consideration for allowing my child to participate in this activity and ongoing YFC activities, I hereby consent to the foregoing on behalf of my child and agree that this release shall be binding upon me, my child, our heirs, legal representatives and assigns.*
I, the undersigned, agree to the terms above.
*
Date
*
-
Month
-
Day
Year
Date
Back
Next
Trip Payment (if you prefer to pay with cash or check, skip this section).
prev
next
( X )
MS W.C. Deposit
The deposit is deducted from the total trip price (not in addition to).
$
30.00
Quantity
1
2
3
4
5
6
7
8
9
10
MS W.C. Early-Bird Full Payment
Price if paid by January 9th
$
60.00
Quantity
1
2
3
4
5
6
7
8
9
10
MS W.C. Regular Full Payment
Price if paid after January 9th
$
80.00
Quantity
1
2
3
4
5
6
7
8
9
10
Payment Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Submit
Should be Empty: