YTH 1 - Student Registration 2025

YTH CAMP 1 - Student Registration

June 2-6, 2025
Church*
*Only check Independent if your church is not coming to this camp
Your church has not signed up for camp yet.

The MAIN CONTACT from your church must fill out the below form.

Church Registration Form
Student Information
First Name*
Last Name*
Birthday*

MonthDayYear
Date
Age*
Grade Next Fall*
Gender (Housed by gender at birth)*

MaleFemale

Parent/Guardian Information - Main Contact
Parent/Guardian Name*

First NameLast Name
Main Phone*
Please enter a valid phone number.
Other Phone
Please enter a valid phone number.
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact - Secondary Contact
Name*

First NameLast Name
Relationship to Camper*
Main Phone*
Please enter a valid phone number.
Other Phone
Please enter a valid phone number.

Student Consent Form
After reading this entire form and the Camp Policies and Procedures, I hereby give permission for my child to attend the Nebraska NxtGen Ministries Camp in 2025.

I further certify that the medical history is correct as far as I know. I acknowledge that in the event of an emergency every effort to contact me and my emergency contact will be made, with that in mind, Nebraska NxtGen Ministries, its agents and employees, have permission to transport my child to such a physician and/or hospital as they may select, and to authorize and secure hospitalization, treatment, surgery, and/or medications for my child as they or the health care professionals involved may deem necessary for my child’s well being. I agree to hold harmless Nebraska NxtGen Ministries, its agents and employees, with respect hereto.

I allow my student to participate in camp recreational activates including but not limited to: Playground, Various field games (splash kick ball, soccer, flag football, etc.), Dodge Ball, Basketball, Indoor swimming pool, Go-Carts, Gyro, Sand Volleyball.

I also understand that participants at The Crossing Retreat Center are liable for damage caused intentionally or maliciously. Damage caused by a participant will be billed directly to the participant responsible and their legal guardian.

I have reviewed the camp dress policies with my child.

DRESS POLICY: Only appropriate and modest clothing is permitted. No clothing portraying indecent, suggestive, or profane writing, pictures, or slogans. No shirts that show midriff or the sides of your torso whether male or female. Ladies: Bra straps/bralettes should be covered. Leggings should be worn with tops that cover to the mid-thigh. Shorts and skirts should be mid-thigh length. A camper/leader may be asked to change at the discretion of camp staff.

I understand that every effort will be made to room church groups in the same cabins. However, due to the structure of the camp and the limited number of beds, this is not always possible.

I give permission to Nebraska Ministry Network to use photographs (individual or group) and/or multimedia images and recordings in the best interest of Nebraska Ministry Network.
Parent/Guardian Signature*

Clear

Credentialed Parent Name*

First NameLast Name
Credentialed Parent Minister ID Number*
Payment
Available Discounts*

Large Family Discount - $30.00
Applies if 3+ students from the same household attend any of the NSM summer camps.PK Discount - $35.00
Applies to students that have a parent who is a NEAG Credentialed Minister.AIM Discount - $50.00
Applies to students that are registered for AIM Trip.None apply

Transportation
Limited Edition T-Shirt - $25
Camp T-Shirt - $20.00
Discounts
Merch
Total Due
EDIT REGISTRATION PRICE HERE
Card Fee
Total w/ Card Fee

PAYMENT MUST BE SUBMITTED TO YOUR CHURCH
$50 of a student's registration fee is non-refundable.

If you are unable to attend Camp a partial refund may be requested. All refunds must be requested at least 1 week prior to the start date of an the week of camp they were attending in order to be valid. If a refund is requested less than 1 week prior to the start date of Camp, no refund is available. Valid refunds will be paid in the same form that the original payment was made.

You can transfer the full amount of registration to another attendee instead of requesting a refund. Please contact us at 308.384.1234 to make this transfer.
Should be Empty:

	First Name	Last Name	Birthday	Camp Attending
Student 1
Student 2
Student 3

Registration	$	280.00
Discounts	-$	{totalDue67}.00
Merchandise	$	{discounts}.00

TOTAL DUE	$	{totalDue}.00

Registration	$	280.00
Discounts	-$	{totalDue67}.00
Merchandise	$	{discounts}.00
Credit Card Fee	$	{merch}

TOTAL DUE	$	{cardFee}

YTH CAMP 1 - Student Registration

Student Information

Parent/Guardian Information - Main Contact

Emergency Contact - Secondary Contact

Student Medical Information

Insurance Information

Student Consent Form

Payment

Credit Card