Sovereign Grace West Region Youth Camp 2026

Name/City of Church (please type city as well as church name as there are many churches with the same name)

Number of Attendees

Attendee Name #1

First NameLast Name

Gender

Age at time of camp (July 2026)

Please indicate the adult attending camp that will be chaperone to underage child. The Chaperone understands and agrees that any child they bring who are underage for Youth Camp remain under their full supervision at all times. The Chaperone accepts full responsibility for any actions, behaviors, damages, or disturbances caused by their child during the event. The Chaperone further agrees to indemnify and hold harmless the organization, its staff, and volunteers from any liability or claims arising from the presence or actions of said child.

Adult or Student

Chaperone's Email

example@example.com

I acknowledge that I have read and understood the above document (Brightlines Form)

Birthday

Date

T Shirt Size

Food Allergies

Environmental Allergies

Any medication that needs to be given at camp (name and dosage)

Are Camp Leaders allowed to administer over the counter medications during camp

Breakout Session 7/11

Breakout Session 7/12

We will be taking pictures to document camp. These pictures may be used by the attending churches and/or Emmanuel Pines for promotional purposes on social media and/or websites. Out of respect for the rights of the parents to maintain control over their own and their children’s presence on the internet, please let us know if you are comfortable with us taking photos and videos of you and/or your children

Attendee Name #2

First NameLast Name

Gender

Age at time of camp (July 2026)

Please indicate the adult attending camp that will be chaperone to underage child. The Chaperone understands and agrees that any child they bring who are underage for Youth Camp remain under their full supervision at all times. The Chaperone accepts full responsibility for any actions, behaviors, damages, or disturbances caused by their child during the event. The Chaperone further agrees to indemnify and hold harmless the organization, its staff, and volunteers from any liability or claims arising from the presence or actions of said child.

Adult or Student

Chaperone's Email

example@example.com

I acknowledge that I have read and understood the above document (Brightlines Form)

Birthday

Date

T Shirt Size

Food Allergies

Environmental Allergies

Any medication that needs to be given at camp (name and dosage)

Are Camp Leaders allowed to administer over the counter medications during camp

Breakout Session 7/11

Breakout Session 7/12

We will be taking pictures to document camp. These pictures may be used by the attending churches and/or Emmanuel Pines for promotional purposes on social media and/or websites. Out of respect for the rights of the parents to maintain control over their own and their children’s presence on the internet, please let us know if you are comfortable with us taking photos and videos of you and/or your children

Attendee Name #3

First NameLast Name

Gender

Age at time of camp (July 2026)

Please indicate the adult attending camp that will be chaperone to underage child. The Chaperone understands and agrees that any child they bring who are underage for Youth Camp remain under their full supervision at all times. The Chaperone accepts full responsibility for any actions, behaviors, damages, or disturbances caused by their child during the event. The Chaperone further agrees to indemnify and hold harmless the organization, its staff, and volunteers from any liability or claims arising from the presence or actions of said child.

Adult or Student

Chaperone's Email

example@example.com

I acknowledge that I have read and understood the above document (Brightlines Form)

Birthday

Date

T Shirt Size

Food Allergies

Environmental Allergies

Any medication that needs to be given at camp (name and dosage)

Are Camp Leaders allowed to administer over the counter medications during camp

Breakout Session 7/11

Breakout Session 7/12

We will be taking pictures to document camp. These pictures may be used by the attending churches and/or Emmanuel Pines for promotional purposes on social media and/or websites. Out of respect for the rights of the parents to maintain control over their own and their children’s presence on the internet, please let us know if you are comfortable with us taking photos and videos of you and/or your children

Attendee Name #4

First NameLast Name

Gender

Age at time of camp (July 2026)

Please indicate the adult attending camp that will be chaperone to underage child. The Chaperone understands and agrees that any child they bring who are underage for Youth Camp remain under their full supervision at all times. The Chaperone accepts full responsibility for any actions, behaviors, damages, or disturbances caused by their child during the event. The Chaperone further agrees to indemnify and hold harmless the organization, its staff, and volunteers from any liability or claims arising from the presence or actions of said child.

Adult or Student

Chaperone's Email

example@example.com

I acknowledge that I have read and understood the above document (Brightlines Form)

Birthday

Date

T Shirt Size

Food Allergies

Environmental Allergies

Any medication that needs to be given at camp (name and dosage)

Are Camp Leaders allowed to administer over the counter medications during camp

Breakout Session 7/11

Breakout Session 7/12

We will be taking pictures to document camp. These pictures may be used by the attending churches and/or Emmanuel Pines for promotional purposes on social media and/or websites. Out of respect for the rights of the parents to maintain control over their own and their children’s presence on the internet, please let us know if you are comfortable with us taking photos and videos of you and/or your children

Attendee Name #5

First NameLast Name

Gender

Age at time of camp (July 2026)

Please indicate the adult attending camp that will be chaperone to underage child. The Chaperone understands and agrees that any child they bring who are underage for Youth Camp remain under their full supervision at all times. The Chaperone accepts full responsibility for any actions, behaviors, damages, or disturbances caused by their child during the event. The Chaperone further agrees to indemnify and hold harmless the organization, its staff, and volunteers from any liability or claims arising from the presence or actions of said child.

Adult or Student

Chaperone's Email

example@example.com

I acknowledge that I have read and understood the above document (Brightlines Form)

Birthday

Date

T Shirt Size

Food Allergies

Environmental Allergies

Any medication that needs to be given at camp (name and dosage)

Are Camp Leaders allowed to administer over the counter medications during camp

Breakout Session 7/11

Breakout Session 7/12

We will be taking pictures to document camp. These pictures may be used by the attending churches and/or Emmanuel Pines for promotional purposes on social media and/or websites. Out of respect for the rights of the parents to maintain control over their own and their children’s presence on the internet, please let us know if you are comfortable with us taking photos and videos of you and/or your children

Attendee Name #6

First NameLast Name

Gender

Age at time of camp (July 2026)

Please indicate the adult attending camp that will be chaperone to underage child. The Chaperone understands and agrees that any child they bring who are underage for Youth Camp remain under their full supervision at all times. The Chaperone accepts full responsibility for any actions, behaviors, damages, or disturbances caused by their child during the event. The Chaperone further agrees to indemnify and hold harmless the organization, its staff, and volunteers from any liability or claims arising from the presence or actions of said child.

Adult or Student

Chaperone's Email

example@example.com

I acknowledge that I have read and understood the above document (Brightlines Form)

Birthday

Date

T Shirt Size

Food Allergies

Environmental Allergies

Any medication that needs to be given at camp (name and dosage)

Are Camp Leaders allowed to administer over the counter medications during camp

Breakout Session 7/11

Breakout Session 7/12

We will be taking pictures to document camp. These pictures may be used by the attending churches and/or Emmanuel Pines for promotional purposes on social media and/or websites. Out of respect for the rights of the parents to maintain control over their own and their children’s presence on the internet, please let us know if you are comfortable with us taking photos and videos of you and/or your children

Contact Name

First NameLast Name

Contact Email

example@example.com

Contact Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Emergency Contact Name and Phone Number (if different than above)

Insurance Information (Insurance name, policy number, member's name and birthday)

I, Attendee #1, acknowledge that I have read and understood the above document (2026 Youth Camp Information Packet)

I, Attendee #2, acknowledge that I have read and understood the above document (2026 Youth Camp Information Packet)

I, Attendee #3, acknowledge that I have read and understood the above document (2026 Youth Camp Information Packet)

I, Attendee #4, acknowledge that I have read and understood the above document (2026 Youth Camp Information Packet)

I, Attendee #5, acknowledge that I have read and understood the above document (2026 Youth Camp Information Packet)

I, Attendee #6, acknowledge that I have read and understood the above document (2026 Youth Camp Information Packet)

I, Parent, acknowledge that I have read and understood the above document (2026 Youth Camp Information Packet)

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Youth Camp 2026

Sign up for Youth Camp! Registration closes June 30, 2026

$325.00 Quantity

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Sovereign Grace West Region Youth Camp 2026

2026 Youth Camp Information Packet

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Refunds are available until June 8, 2026. Cancelations after that date may not be refunded.

My Products - Make sure to change the quantity to reflect the number of attendees