Youth Camp 2024 Individual Registration Form

Youth Camp 2025 Individual Registration Form
Participant Information

Información del Participante
Name*

First Name (Nombre)Last Name (Apellido)
Check one*

MaleFemale
Age*
(Edad)
Phone Number*
(Numero Telefonico)
E-mail*
(Correo Electronico)
Address*

Street Address (Direccion)

City (Cuidad)State (Estado)

Zip Code (Codigo Postal)
Church Name*
(Nombre de Iglesia)
Are you registering as a Counselor? (NOTE: Counselors must be 23 years of age)*

YesNo
Pastor's Signature of Approval for Counselors
(Firma del Pastor para los Consejeros)
Registrations submitted after July 9th will require you to stay off-campus, select below to acknowledge*

Off-campus
Please select your T-shirt Size (Note: A shirt is not guaranteed if registering after July 9th)*

SmallMediumLargeXL2XL3XLOther
Health Information

Información de Salud
Emergency Contact (Contacto de Emergencia)*

First Name (Nombre)Last Name (Apellido)
Relationship to Participant*
(Relacion con el participante)
Phone Number*
(Numero Telefonico)
Allergies and Medication

Alergias y Medicamentos
Please list any allergies (including food allergies)*
(Indique caulquier alergia incluidas las alergias alimentarias)
Please list any medications you take regularly and how often:
(Enumere los medicamentos que toma)
Insurance Information

Información del seguro
Insurance Company Name*
(Nombre de compania de seguros)
Insurance Policy Number*
(Numero de poliza de seguro)
Liability Release Form

Formulario de liberación de responsabilidad
By participating in Youth Camp 2025 in Kenedy, Texas, I, Name of Particpant understand that the purpose of Youth Camp is a genuine encounter with the Lord. To that end, I have read and understand the information and rules for attending Youth Camp. I pledge to abide by all rules and regulations set forth by its director including but not limited to: the dress code, the prohibition of cell phone usage in restricted areas while on grounds, and instructions from YUFC functionaries.
Participant's Signature*
(Firma del participante)
As a legal adult or parent/guardian of the above, I do hereby release, forever discharge and agree to hold harmless Youth United For Christ of Unified Pentecostal Local Church Int'l, Inc., and the directors thereof from any and all liability claims or demands for personal injury, sickness, or death, as well as property damages and expenses of any nature whatsoever which may be incurred by the undersigned and participant that occur while said person is participating in the above described event, and it's activities including recreational activities. The undersigned hereby agree to hold harmless and indemnify said church/group, its director's sustained by said acts of said participants, including expenses incurred attendant thereto.
The undersigned further consents to the administration of first-aid and/or doctor's care, or any other form of medical treatment necessitated by illness or injury that may require the same. In the event of the necessity of such are or treatment described, the undersigned agrees to indemnify said church, its directors, and agents from any acts of malfeasance, and/or failure to act on the part or those chosen to administer medical care on behalf of the participant.
Participant's Signature (or Parent/Guardian's Signature if Participant is under 18 years of age)*
(Firma del participante o de los Padres)
Registration Confirmation

Confirmación de Registro
Your registration is not complete until you have paid the registration fee. Please check one of the following options as an assurance that you have done one of these things:
You may pay the registration fee with Cash/Check or through ONLINE PAYMENT by typing this link: https://shorturl.at/PCaBK*

I will pay $125 on or before July 23rd via Online Payment or cash/check (In-State Registration)I will pay $65 on or before July 23rd via Online Payment or cash/check (Out-of-State)
Should be Empty:

Youth Camp 2025 Individual Registration Form

Participant Information

Health Information

Allergies and Medication

Insurance Information

Liability Release Form

Registration Confirmation

Your registration is not complete until you have paid the registration fee. Please check one of the following options as an assurance that you have done one of these things: