Youth Camp Registration Form
July 15-18, 2026
Participants Details
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Home/VP Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Participant's Mobile Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Participant's E-mail
*
example@example.com
Age Year
*
Please Select
13
14
15
16
17
Leader
Participant must be turning 14 in 2026 to be able to attend the conference
Gender
*
Male
Female
Date of Birth
*
-
Month
-
Day
Year
Date
Shirt Size
*
Please Select
XS
S
M
L
XL
2XL
3XL
4XL
These are adult sizes; not youth sizes
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Parent/Emergency Details for Correspondance
Parent/Guardian Name
*
First Name
Last Name
Parent Mobile Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Parent email
*
example@example.com
Emergency Contact 1
Emergency Contact Name
*
First Name
Last Name
Emergency Mobile Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Relationship to Participant
*
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Medical Details
Physician Name
*
Physician Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Health Insurance Provider
*
Insurance Policy Number
*
Does the participant have any dietary needs or food allergy?
*
Yes
No
If Yes, please specify dietary needs or food allergies.
Does the participant have any health condition(s)
*
Yes
No
Is the participant known to have
Diabetes
Dizzy spells
Blackouts
Travel Sickness
ADHD or similar
Heart Condition
Asthma
Migraines
Epilepsy
Bed Wetting
Sleep Walking
Allergies
Other
If select Allergies or Other, please provide details
Will the participant be bringing any medication to the camp?
Yes
No
If Yes, please provide details
Will the participant be able to take their own medication independently during camp? Participants who cannot manage their own medication will not be able to attend camp.
*
Yes
No
Do you give permission for common over-the-counter pain relief for minor pain or headaches, and for allergy medication if needed?
Yes
No
Has the participant had any recent illnesses or operations/surgeries
Yes
No
If Yes, please specify
Please rate the participants swimming ability
*
Please Select
Poor
Fair
Good
Excellent
Is there any other information about the participant that you should disclose in order to protect their, or others, health, safety, comfort, or wellbeing?
Yes
No
If Yes, please specify
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Registration confirmation
Permission & Medical Release Form
I understand that my camp registration is NOT confirmed until I have submit my signed Permission and Medical Release form.
*
Yes
I understand that my camp registration is NOT confirmed until I have submit the payment to the church.
*
Yes
I understand that my camp registration is NOT confirmed until my payment has been received in full by the due date.
*
Yes
Submit Form
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