YC 26 Wonderfully Made One-Day Camp Registration

Into the Unknown: Wonderfully Made One-Day Camp Registration

Please use this form to register the student/young adult as well as the parent/caregiver who will be attending with the student/young adult.

June 19th

Lake Wimauma

9:30-10:00 AM Check in

10 AM Event Kickoff

3PM Event Conclusion

This event is being offered at no cost!

We only ask that if you register for the event & are unable to attend, you notify Nicole Pope via email nicole@flcog.cc

This one-day experience will include sensory-friendly activities, a catered allergy-sensitive lunch, and experiences designed specifically for children and young adults with diverse abilities—offering them a full, one-day “youth camp” experience. This event is open to students (ages 4 & above) through young adults with diverse abilities.

While we plan to have many volunteers for this event, due to the unique needs of each student, children and young adults must be accompanied by a parent or caregiver for the day.

A detailed schedule & information will be email to the email address provided in this registration no later than June 10th.
Camper Info

Please fill out your child's information
Student's Name

First NameLast Name
Student's Age
Select One
Date of Birth

MonthDayYear
Date
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Father/Guardian Full Name

First NameLast Name
Mother/Guardian Full Name

First NameLast Name
Parent/Guardian Phone Number

Area CodePhone Number
Parent/Guardian Email Address
example@example.com
Campers t-shirt size: Each camper will receive a FREE youth camp t-shirt. Additional shirts may be purchased on the event date.

Church Information

Please fill out your church information
Do you currently attend a local Church of God?
Name of local church you attend
Pastor's Name

First NameLast Name

Camper Agreement
As a camper of the Church of God Youth Camp, I agree to abide by the rules and policies of the camp during my stay at camp. I understand that any deliberate breach of conduct or disregard of camp rules will necessitate disciplinary action, even to the extent of being asked to leave the camp. I understand that the Florida Church of God Youth Camp is a private Church and Christian camp. I agree to conduct myself according to the principles and biblical beliefs of the Church of God during my participation at the camp. Any conduct which violates these principles and beliefs may be grounds for my dismissal from the camp, the transportation and other costs of which will be my responsibility. The camp administration retains full and sole discretion to dismiss me from the camp, for any reason it deems necessary.
Campers Name

First NameLast Name
Camper Signature
Parent / Guardian Signature
Date

MonthDayYear
Date
Allergies / Food Allergies
Write none if question does not apply
Parent / Guardian must complete this section

I understand the camp insurance policy provides secondary coverage ONLY. My insurance will provide primary coverage. I hereby consent to allow camp officials to seek and secure medical treatment for my child in the event of an emergency. I have attached a copy (front & back) of my insurance card. As parent/guardian of the above child, I affirm that the information on this application is true and correct and that in case of illness or accident, you have my permission to administer first-aid and to secure medical attention for my child. Furthermore, I hereby authorize the release of all medical records (x-rays, test results, etc.) resulting from treatment, to the Church of God Youth Camp. I also give my permission for my child to participate in and travel to any off-site activity sponsored by the camp.
Parent / Guardian Signature
Date

MonthDayYear
Date
Please list the parent/caregiver who will be attending with the day camper. Only the name listed below will be allowed to attend Wonderfully Made One-Day Camp. Due to space restrictions, we ask that no more than 2 adults attend with the student.
Parent/Caregiver 1

First NameLast Name
Phone Number

Area CodePhone Number
Relationship to Student
Parent/Caregiver 2

First NameLast Name
Phone Number

Area CodePhone Number
Relationship to Student
Please list anything that you would like us to know about your student.
Parent / Guardian Signature
Date

MonthDayYear
Date
Should be Empty:

Into the Unknown: Wonderfully Made One-Day Camp Registration

Camper Info

Church Information

Camper Agreement

Parent / Guardian must complete this section

Please list the parent/caregiver who will be attending with the day camper. Only the name listed below will be allowed to attend Wonderfully Made One-Day Camp. Due to space restrictions, we ask that no more than 2 adults attend with the student.