Clone of 2025 Hiawatha Youth Camp Registration

2026 Hiawatha Youth Camp Registration

We are so excited to have you join us this summer at HYC at our new home in Allegan! Please fill out all sections of the form, click submit, and you'll be officially registered for HYC. After submitting your registration, you'll receive an email containing a link to the Hiawatha Paypal payment option. You can pay for your week(s) at HYC online. Please don't hesitate to contact the HYC office with any questions at (734) 284-0200.
Camper Name*

First NameMiddle NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
E-mail*
Camper Birthdate

MonthDayYear
Date
Camper Gender

MaleFemale
Are you coming with a group/ organization?

YesNo
If yes, what church do you attend?
Who is your Youth Pastor/ Leader?
Emergency Contact Information

Please enter the name of the parent or guardian who should be contacted in the case of an emergency.
Name*

First NameLast Name
Relationship to Camper*

ParentGrandparentLegal GuardianOther
EMERGENCY CONTACT PHONE #1*

Area CodePhone Number
EMERGENCY CONTACT PHONE #2

Area CodePhone Number

CHOOSE YOUR WEEK

Let us know when you're coming! Please note: if you are registering a camper from the UP or are only paying the $50 deposit at this time, please download the registration form on our website and follow instructions there. www.hiawathayouthcamp.com/registration

Choose Your Week(s) at HYC!

July 6 - July 11 | Junior Camp | Speaker: Rebecca Adkins$350.00

July 12 - July 18 | Teen Week 2 | Speaker: Dan Adkins$350.00

Enter coupon

Total $0.00

If you selected the $50 deposit option, please select which week you are registering for.
Roomie Request: (Just a request, not a guarantee)

First NameLast Name
Friend Referral: (Let us know who invited you so we can thank them!)

First NameLast Name
HYC BUS TRANSPORTATION

Bus transportation is currently not available for this coming summer. Sorry for any inconvenience.

CAMPER INSURANCE INFORMATION

In Case of an Emergency
Health Insurance Company*
Policy/ Account #*
Group #*
I hereby give permission for routine health care provided by Hiawatha Youth Camp, and in case of emergency, to the licensed physician selected by the camp to hospitalize, secure proper treatment, and authorize anesthesia or surgery for the child named on this form.*

YesNo
I hereby give permission to Hiawatha Youth Camp to transport the child named on this form off of the camp premises for purposes of field trip activities.*

YesNo
I hereby give permission to Hiawatha Youth Camp to use photos/videos of the child named on this form for the purposes of promoting the camp, and waive all claims to compensation for the use of his/her likeness.*

YesNo
Please type name of Parent/ Guardian granting permission.

CAMPER PAYMENT INFORMATION

HYC strives to keep camper costs low so that everyone is able to attend no matter their financial situation. If you have financial need, please contact the HYC office to request financial aid information. When you submit this form, you will be directed to: "http://hiawathayouthcamp.com/payment.htm" From there, you'll be able to select your date(s), finalize payment, and be officially registered for HYC!
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2026 Hiawatha Youth Camp Registration