• Church Camp Registration Form

  • Camper Information

    Please submit one form per camper
  • PARENT/GUARDIAN INFORMATION

  • Emergency Contact (other than the parent above)

    In the case that we are unable to reach you in an emergency, please provide the name and number of someone we can contact (other than the parent above).
  • Application Consent

  • I understand and acknowledge the following:

    Emergency Contact Information: I have provided accurate emergency contact information, including my contact number, an alternate contact person, and their contact details. In case of any emergency, I authorize Liberty Association Youth Camp staff to contact me or the designated alternate contact.
    Medical Authorization: I authorize Liberty Association Youth Camp staff to seek and obtain necessary medical treatment for my child/ward in the event of illness, injury, or any other medical emergency. I understand that Liberty Association Youth Camp staff will make every effort to contact me or the emergency contact person before seeking medical treatment, but they may proceed with necessary medical care if deemed urgent.
    Camp Rules and Expectations: I have reviewed and discussed with my child/ward the rules, expectations, and code of conduct for Liberty Association Youth Camp. I understand that my child/ward is expected to adhere to these guidelines throughout the camp duration.
    Photo and Video Release: I grant permission for photographs and videos of my child/ward to be taken during the camp for promotional, educational, and archival purposes by Liberty Association Youth Camp. I understand that these images may be used in printed materials, online media, and presentations related to Liberty Association Youth Camp.
    Transportation: I authorize Liberty Association Youth Camp staff to provide transportation for my child/ward as necessary during the camp activities. I understand that all safety precautions will be taken during transportation.
    Liability Release: I release Liberty Association Youth Camp, its staff, volunteers, and affiliates from any liability for injuries, accidents, or loss of personal property that may occur during the Church Camp.
    By signing below, I confirm that I have read, understood, and agree to the terms and conditions outlined in this consent form. I hereby give my permission for my child/ward to participate in Liberty Association Youth Camp and engage in all planned activities.

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  • Camp Fee is $175.00 per camper, paid to your local church.

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