OVCYC Registration Form

Ohio Valley Christian Youth Camp
Registration Form
Desired Week(s):*

Senior Week- June 14-19 (ages 14-19)Intermediate Week- June 21-26 (ages 11-14)Junior Week- June 28-July 3 (ages 7-11)
Camper's Name*

First NameLast Name
Gender*

MaleFemale
Birth Date*

MonthDayYear
Date
Age*
Grade in Fall*
Address:*

Street Address

CityState / Province

Postal / Zip Code
E-mail*
example@example.com
Phone Number*
Format: (000) 000-0000.
Home Congregation
Member?

YesNo
Parent & Guardian Information
Father's Name:*
Father's Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Mother's Name:*
Mother's Phone Number
Please enter a valid phone number.Format: (000) 000-0000.

Emergency Contact

Please list at least one contact that will not be on staff the same week as your child.
Emergency Contact #1 Name:*
Emergency Contact #1 Phone Number:*
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact #2 Name:*
Emergency Contact #2 Phone Number:*
Please enter a valid phone number.Format: (000) 000-0000.
I authorize the following individuals to pick up my child (in addition to his/her parents):
If your teenager plans to drive him/herself, please list him/her here. Be sure to list any siblings that your child can ride home with as well.
List any individuals that are NOT allowed to pick up your child:
If there any commitments that will require your child to leave camp early or any time during the week, please specify which day(s) and time(s) he or she will need to leave:
Please list important information that the counselors/staff should know about your child:
Special Requests to be assigned to the same side of the dorm as a few campers or counselors:

Ohio Valley Christian Youth Camp

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