2026 Youth Camp Detailed Student Registration Form

2026 Youth Camp Student Registration

For students from 7th grade to 18 years old. Camp Fee: $180 per participant. If you are not part of a church group, the camp fee can be paid by cash or check payable to RCBA Youth Camp on the first day of camp. Churches may scholarship their students or collect the camp fee prior to registration. If you do need assistance with this form or with the camp fees, please contact us as early as possible. Some people have had difficulty with getting the form to register. Please make sure all the questions with a red asterisk are filled out and make sure to sign the form at the bottom.You should get a message after hitting "Submit" which says to "Sign Document". You'll need to click that button and then you will see the "Thank You" message indicating your form has been completely submitted and received. If you have questions - email us at smbayouthcamp@gmail.com. If you'd rather print and fill in the form, there is a button at the bottom of the form which will let you do that.
Student's Name

First NameLast Name
Student's Birth Date

MonthDayYear
Grade entering in school
If the student is a High School graduate - please use 13.
Gender
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent / Guardian Information
Name

First NameLast Name
Parental Cell Number
Format: (000) 000-0000.
Secondary Phone Number
OptionalFormat: (000) 000-0000.
E-mail: Parental
example@example.com
What church is the student attending camp with?
What church is the student a member of? (If different from the one they are attending camp with.)
Emergency Information
Emergency Contact's Name

First NameLast Name
Relationship
Phone Number
Format: (000) 000-0000.
Alt. Phone Number
Format: (000) 000-0000.
Secondary Emergency Contact's Name

First NameLast Name
Relationship
Phone Number
Format: (000) 000-0000.
Medical Information
Family Physician and contact info
If no family physician - please indicate such.
Family Insurance:
If uninsured - please indicate that in this field.
Is the student on any medication? If yes, please list and explain any instructions.
Does the student have any allergies, chronic illness, or medical conditions? If yes, please describe.
Medical issues: Please indicate all which apply

Other: Please indicate in the box above.
Has your child recently been exposed to any contagious or infectious diseases or illnesses?
Other comments about this student which the Camp Nurse and Camp Director should know or be aware of?
In a non-emergency situation should your child need attention by the Camp Nurse for common issues like sun burn, itching, headache, upset stomach, etc. - are there any medications the child CAN NOT take?
Informed Consent and Acknowledgement I hereby give my approval for my child’s participation in any and all activities prepared by SMBA Youth Camp during July 13-17, 2026. I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless SMBA Camp and all its respective officers, agents, and representatives from any and all liability for injuries to this child arising out of traveling to, participating in, or returning from selected camp sessions. In case of injury to this child, I hereby waive all claims against SMBA Camp, including all leaders and affiliates, all participants, sponsoring agencies, and, if applicable, owners and lessors of premises used to conduct the event. I acknowledge there is a risk of being injured that is inherent in all sports and other physical activities which are generally conducted at youth camp.
Photo Release: I give permission for any pictures of my child engaging in normal camp activities - recreation, worship, mission projects, etc. - to be used in social media posts promoting the activities at camp during this week.
Medical Release and Authorization As Parent and/or Guardian of the named student, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed. Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for the named athlete. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact me in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach me.

Permission is also granted to the SMBA Camp and its affiliates including Directors, Sponsors, and onsight Adults to provide the needed emergency treatment prior to the child’s admission to the medical facility. Release authorized on the dates and/or duration of the registered camp.

This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named minor child, in my absence.
Confirmation: By acknowwledging and signing below, I am delivering an electronic signature that will have the same effect as an an original manual paper signature - which I undertand will be equally binding as a physical signature on this form.
If you have comments, concerns, or need exceptions to any of the above releases, please list those here.
Signature

Binding Signature of Parent/Guardian
If you are not part of a church group, the camp fee can be paid by cash or check payable to RCBA Youth Camp on the first day of camp. Churches may scholarship their students or collect the camp fee prior to registration.

If you do need assistance with this form or with the camp fees, please contact us as early as possible.

Some people have had difficulty with getting the form to register.

Please make sure all the questions with a red asteric are filled out and make sure to sign the form.

You should get a message after hitting "Submit" which says to "Sign Document". You'll need to click that button and then you will see the "Thank You" message indicating your form has been completely submitted and recieved.

If you have questions - email us at smbayouthcamp@gmail.com.
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2026 Youth Camp Student Registration