General Youth Conference 2
General Youth Conference 2 is July 13-18, 2026! Are you ready for GYC2?! We hope so, because it’s time to sign up for camp! A Christ-focused week filled with Christian instruction, worship, recreation, music, service, and fun, GYC2 is for those youth that have completed 3rd through 12th grades. FOR 2026, THE GYC2 THEME IS “Rooted”. The cost for GYC2 is $445.00. This price includes transportation, lunch on the way to and from camp, lodging and meals at Cragmont, snacks, a group picture, a T-shirt, a day trip and other camp activities. PLEASE NOTE: Instead of having money on the bus traveling to and from camp, we have built those two lunches into the price this year. We will be stopping at Golden Corral on the way there and back. Again, those two lunches are built into the price this year instead of being held by the bus captains. In order to secure your space at GYC2, you need to fully complete all of the following forms: 1. Registration Form 2. Medical Form & Copy of Insurance Card 3. Liability Release Form. You then need to submit ALL forms and a $175.00 deposit, with checks made payable to GYC2 AS SOON AS POSSIBLE! If you wait around to send in your forms and deposit, there’s a good chance you may end up waitlisted! All forms will be submitted here, but checks and insurance card copies are to be sent to: Wilma Parker, Registrar 1190 Highway 258 North, Kinston NC 28504. The remaining $270.00 is due by June 14th. And after June 14th, all deposits are non-refundable. All money is due BEFORE campers arrive at camp. About two weeks before camp, an Information sheet will be sent with specific details about the week. PLEASE TAKE NOTE: Over the past few years, there has been an increase in campers leaving GYC2 before the end of camp in order to attend other activities. It is our main goal at GYC2 to spend the full week working with you. Therefore, if you are planning to leave GYC2 before Saturday, we ask that you graciously opt out of camp and allow space for those campers who would like to attend for the entire week. If you have any questions about registration or need more information, please contact Wilma by phone, text, or email at: 252-560-2026 wilmaparker@duck.com
Student Name
First Name
Middle Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Age of Camper (as of camp date)
Please Select
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Birth Date
Please select a month
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Year
Gender
Please Select
Male
Female
N/A
Home Church
School You Will Be Attending in the Fall
Student E-Mail
example@example.com
Parent E-Mail
example@example.com
Student Mobile Number
Format: (000) 000-0000.
Parent/Guardian Phone Number
Format: (000) 000-0000.
Grade Completed
Please Select
3rd
4th
5th
6th
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8th
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12th
T-Shirt Size
Youth Small
Youth Medium
Youth Large
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X-Large
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XXX-Large
XXXX-Large
I want to ride the bus with _________ (Church) from __________ (city).
If possible I would like to room with... (up to 3 roommates)
**If a church will be paying the cost for this camper, please note the church's name below:
Back
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Liability Release Form
In consideration for being accepted by General Youth Camp2 (GYC2) and Cragmont Assembly, INC. (Cragmont) for participating in all camp related activities from July 13-18, 2026, we being 21 years of age or older, do for ourselves and for and on behalf of our child-participant if said child is not 21 years of age or older do hereby release, forever discharge and agree to hold harmless GYC2 and Cragmont, and its officers, directors, members, agents, servants, and employees from any and all liability, claims or demands for personal injury, sickness or death, as well as property damage and expenses, of any nature whatsoever which may be incurred by the undersigned and/or the child-participant that occur while said child- participant is participating in the above described activity. Furthermore, we for ourselves and on behalf of our child-participant if under the age of 21 years hereby assume all risk of personal injury, sickness, death, damage and expense as a result of participation in recreation and activities involved. Further, authorization and permission is hereby given to GYC2 to furnish any necessary transportation, food and lodging for this participant. The undersigned further hereby agree to hold harmless and indemnify GYC2 and Cragmont, its officers, directors, members, agents, servants, and employees for any liability sustained by said groups as the result of the negligent, willful or intentional acts of said participant, including expenses incurred attendant thereto. We are the parents or legal guardians of this participant, and hereby grant our permission for him/her to participate fully in said trip, and hereby give our permission to take said participant to a doctor or hospital and hereby authorize medical treatment, including but not in limitation to emergency surgery or medical treatment, and assume the responsibility of all medical bills, if any .Further, should it be necessary for the participant to return home due to medical reasons, disciplinary actions or otherwise, we hereby assume all transportation costs. The use of plurals such as “we, ourselves,” etc., is intended to also encompass the singular and should be read as “myself” etc., where appropriate.
Partipants Signature
Date
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Month
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Day
Year
Date
Parent/Legal Guardian Signature
Date
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Month
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Day
Year
Date
Parent/Legal Guardian Signature
Date
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Month
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Day
Year
Date
Printed Name of Camp Participant
First Name
Last Name
Printed Name of Person Responsible
First Name
Last Name
Date
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Month
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Day
Year
Date
Parent/Legal Guardian Signature
GYC2 Medical Form
For Cragmont Assembly
Name
First Name
Last Name
DOB:
-
Month
-
Day
Year
Date
Age
Home Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Gender
Social Security # (This is for medical emergencies only and will not be given out otherwise)
Mailing Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Family Doctor/Medical Practice
Family Doctor/Medical Practice Phone #
Mother's Name
First Name
Last Name
Mother's Cell #
Please enter a valid phone number.
Format: (000) 000-0000.
Mother's Work Phone #
Please enter a valid phone number.
Format: (000) 000-0000.
Father's Name
First Name
Last Name
Father's Cell #
Please enter a valid phone number.
Format: (000) 000-0000.
Father's Work Phone #
Please enter a valid phone number.
Format: (000) 000-0000.
INSURANCE INFORMATION / PARENT OR LEGAL GUARDIAN CONSENT
By my signature, I understand and agree to the following: Costs for all treatment/medicine will be the responsibility of the parent/legal guardian. Campers are covered by camp insurance with secondary coverage from the time they board their unit of transportation until they return to their terminal; however, this will only cover accidents. Secondary coverage pays after my insurance. I have provided this insurance information in the event that my child should need treatment by a physician/hospital:
WE MUST HAVE A COPY OF ALL INSURANCE CARDS, FRONT AND BACK(THIS INCLUDES MEDICAID CARDS)
Please scan and email these to Wilma or mail them in with your deposit check! 252-560-2026 wilmaparker@duck.com. Please be sure to send a COPY of your insurance information. Please do not send original insurance cards and information.
PRIMARY INSURANCE INFORMATION
Company Name
Insured Cardholder's Name
First Name
Last Name
SSN:
DOB:
-
Month
-
Day
Year
Date
Subscriber #
Policy #
Group #
Secondary Insurance Information
Company Name
Insured Cardholder's Name
First Name
Last Name
SSN:
DOB:
-
Month
-
Day
Year
Date
Subscriber #
Policy #
Group #
Emergency Contacts
Names and Relationships to Camper
Emergency Contact # 1
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact #2
Please enter a valid phone number.
Format: (000) 000-0000.
Permission to Treat
If a camper requires confinement for illness for twenty-four (24) hours or more, the parent/legal guardian will be notified to pick up the camper. It is my responsibility not to send a sick child to camp. If my child has fever and/or any contagious condition the first day of camp, I am instructed not to send him/her to camp. I will be asked to come to Cragmont Assembly to pick up my child if he/she is deemed sick with a contagious condition. All possible care will be used to prevent any accident and assigned adults will be responsible to see that any camper who gets sick or injured receives proper attention. I will be notified of any serious illness or accident. I hereby give permission to Cragmont Assembly, Incorporated and its authorized representative to consent for medical/surgical treatment for the above named camper (my minor child) as is deemed necessary.
Parent/Legal Guardian Signature:
Name
First Name
Last Name
Date
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Month
-
Day
Year
Date
Personal History and Information
Allergies (Please include drugs, food, seasonal, & insect bites)
Date of Last Tetnus Shot
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Month
-
Day
Year
Date
Does camper have special diet needs? If so, please give specific instructions below:
List of all medications the camper is currently taking, both prescribed and OTC:
PLEASE DO NOT SEND OTC MEDICATIONS WITH YOUR CHILD, THEY WILL BE PROVIDED AS NEEDED. LIST ANY OTC MEDICATIONS YOU DO NOT WANT YOUR CHILD TO RECEIVE:
IS THERE A HISTORY OF ANY OF THE FOLLOWING DISEASES IN THE CAMPER’S FAMILY (PARENTS, SIBLINGS AND / OR GRANDPARENTS)? (PLEASE CHECK ALL THAT APPLY)
Diabetes
High Blood Pressure
Heart Trouble
Cancer
Other Hereditary Disease (specify):
Please check any of the following that apply to this camper:
Anxiety
Arthritis
Breathing Problems (Asthma, Etc.)
Cancer
Depression
Diabetes
Dizziness
Fractures
Headaches
Heart Problems (Murmurs, Etc.)
High Blood Pressure
Hyperactivity
Infectious Disease (TB, Hepatitis, Etc.)
Joint Problems
Kidney/Bladder Problems (UTI, Bedwetting, Etc.)
Liver Problems
Menstrual Problems
Seizures
Skin Problems
Sleepwalking
Stomach Problems
Strep Throat
Thyroid Problems
Tonsillitis
Vision/Hearing Problems
Please explain any checked answers:
Previous hospitalization / surgeries / procedures:
Does the camper have any physical limitations? If yes, please be specific:
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