2025 Student Camp- THE CHASE -PURSUE 2025 -Student (Ages 12-18 )
July 1st-5th, 2025
Name
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First Name
Last Name
Email
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example@example.com
Phone Number
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Please enter a valid phone number.
Format: (000) 000-0000.
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Gender
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Male
Female
Grade
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Birthday
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Contact Information
Name
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First Name
Last Name
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
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example@example.com
Notes
Contact Type
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Parent
Guardian
Other
Age at date of camp
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Can your child swim?
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Roommate Request
If you would like to request a roommate, enter their full name and church in the notes. We will do our best to honor your request; however, it is not guaranteed.
T-shirt size (Youth small - Adult 4x)
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Medical
Complete all Medical information. if an item does not apply, type N/A in the notes
Allergies
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Medications
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Other Health History
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Insurance
I hereby give my permission to the physician, nurse or dentist selected by the representative of the PA Church of God State Office, during the 2025 Youth Camps to secure medical and dental aid as required for illness or injury under a physicians orders, including transportation to and from the necessary facilities. I ASSUME ALL FINANCIAL RESPONSIBILITIES, IF MEDICAL TREATMENT IS REQUIRED FOR ANY REASON.
Insurance Provider, Policy #, Group #
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Physician Name and Phone
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Over-the-Counter Medication
I hereby give my permission to the physician, nurse or dentist selected by the representative of the PA Church of God State Office, during the 2025 Youth Camps to secure medical and dental aid as required for illness or injury under a physicians orders, including transportation to and from the necessary facilities. I ASSUME ALL FINANCIAL RESPONSIBILITIES, IF MEDICAL TREATMENT IS REQUIRED FOR ANY REASON.
Allowed Medications
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Benadryl
Ibuprofen
Tylenol
Antacid
Topical Ointment
Eye Drops
None
Electives
Each Camper can choose 2 electives, One social and one spiritual. These sessions will equip students with skills to be Pursue Christ in their faith walk.
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Elective A-Leadership Development- Building and developing dynamic leadership skills.
Elective B-Tech- Multimedia-Graphic designs and editing
Elective C-Praise Dance-Creative movement, expressing faith and worship through dance.
Elective D-Arts and Writing, Developing your creative abilities through the Arts & Writing.
Elective E-Human Video-Expressing Faith beyond words through drama.
Elective F-Drama/Skit-Creating Skits with Purpose.
Elective G-Soccer
Elective H-Basketball
Elective I-Volleyball
Elective J-Cross Camp Running
Elective K-Choir
Consent and Liability
I hereby acknowledge that it is my desire for my child to be a participant in the 2025 Pennsylvania Church Of God Youth Camp, including all activities associated with this event, as well as transportation to and from this event and its related activities. I am (my child is) voluntarily participating in this event, including transpotation to and from he event, and its related activities with knowledge of the dangers involved and hereby agree to accept any and all risks of injury as a result of such participation and transportation. As lawful consideration for permitting me (my child) to participate in the 2025 Pennsylvania Church Of God Youth Camps, including transportation to and from this event and all its related activities, I hereby release and discharge the Church of God State Offices and Church of God Youth Camp, its officers, employees, agents and members of the Board of Trustees from all actions, claims or demands I and my heirs, distributes, guardians, legal representatives or assigns now have or may hereafter have for any injury or damages resulting from the negligence or other acts, howsoever caused, by such church, officers, employees, agents and Board of Trustees, before or during my (child's) participation in this sponsored activity on and/or away from these premises, including transportation to and from the group activity area and other transportation provided for related activities. I approve of my child participating as part of the 2025 Pennsylvania Church Of God Youth Camp program, including any project or activity outside Bongiorno Conference Center, Carlisle PA. The minor named above (or myself if over 18) will participate as a camper in the Church of God youth camping program which runs from July 01-05, 2025. I HAVE CAREFULLY READ THIS AGREEMENT AND FULLY UNDERSTAND ITS CONTENTS.
Waiver and Liability
WAIVER OF LIABILITY AND RELEASE ACKNOWLEDGEMENT. PLEASE CONFIRM THAT YOUR EMAIL IS CORRECT. Thank you for registering for PURSUE CAMP! Please be aware that we have a strict no-refund policy for cancellations. Once camper registration is confirmed and payment is processed, no refunds will be issued under any circumstances, including but not limited to illness, emergencies, or changes in personal circumstances. We highly recommend reviewing your schedule and ensuring your availability before completing your registration. If Camper is unable to attend, we encourage you to transfer your spot to another Camper, subject to availability and approval. By registering for the camp, you agree to this no-refund policy. I hereby acknowledge and give permission for my child to be a participant in the 2025 Pennsylvania Church Of God Youth Camp, including all activities associated with this event, as well as transportation to and from this event and its related activities. I am (my child is) voluntarily participating in this event, including transportation to and from he event, and its related activities with knowledge of the dangers involved and hereby agree to accept any and all risks of injury as a result of such participation and transportation. As lawful consideration for permitting me (my child) to participate in the 2025 Pennsylvania Church Of God Youth Camps, including transportation to and from this event and all its related activities, I hereby release and discharge the Church of God State Offices and Church of God Youth Camp, its officers, employees, agents and members of the Board of Trustees from all actions, claims or demands I and my heirs, distributes, guardians, legal representatives or assigns now have or may hereafter have for any injury or damages resulting from the negligence or other acts, howsoever caused, by such church, officers, employees, agents and Board of Trustees, before or during my (child's) participation in this sponsored activity on and/or away from these premises, including transportation to and from the group activity area and other transportation provided for related activities. I approve of my child participating as part of the 2025 Pennsylvania Church Of God Youth Camp program, including any project or activity outside Bongiorno Conference Center, Carlisle PA. The minor named above (or myself if over 18) will participate as a camper in the Church of God youth camping program which runs from July 1-5, 2025. I further understand that during the course of events my child may be photographed and /or videoed for promotional or ministry remembrance purposes.I also grant permission to the above organization to use my child’s photo and or video for ministry purposes. I hereby commit that my child will abide by the rules and regulations of the camp to ensure a safe and enjoyable experience. I understand that students are not to bring expensive electronics, video games, guns , knives, laser pointers, fireworks, expensive jewelry etc. Church of God State Offices and Church of God Youth Camp, its officers, employees, agents and members of the Board of Trustees will not be responsible for stolen, damage or lost items. I HAVE CAREFULLY READ THIS AGREEMENT AND FULLY UNDERSTAND ITS CONTENTS.
Signature
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