Heartland Church Renovate Youth

Heritage Crossroads Youth Group
Camp 2026 Registration Form
Youth's Information
Youth Name:
T-Shirt Size:
Parent/Guardian Information
Full Name:

First NameLast Name
Relationship to Participant:
Phone Number:
Format: (000) 000-0000.
Email Address:
example@example.com
Emergency Contact Information
Emergency Contact 1 Name:
Emergency Contact 1 Phone:
Format: (000) 000-0000.
Emergency Contact 2 Name:
Emergency Contact 2 Phone:
Format: (000) 000-0000.
Medical Information
Allergies/ Medical Concerns:
Additional Information
Please provide any additional information or requests here:
Permissions and Agreements
I, the parent/guardian, give permission for my child to attend the 2026 Renovate Youth Camp by Heartland Church. I acknowledge inherent risks and release Heartland Church and staff from liability. In emergencies, if unreachable, I authorize medical care. I have provided relevant medical/allergy info. By signing, I agree to this waiver. I understand that photos or videos may be taken during camp activities and used for promotional materials.
Payment Information
A $100 camp registration fee is required. Please use the link below to complete payment. Please put the youth's name and CAMP 2026 in the Notes field.
https://secure.myvanco.com/YJ06/campaign/C-16BTX?access=tile_direct
Parent/Guardian Signature:
Date:

MonthDayYear
Date
Should be Empty:

Heritage Crossroads Youth Group