Lift Student Ministries Camp 2026 Permission & Medical Release Form

Lift Student Ministries Camp 2026 Permission & Medical Release Form
Please fill out this form in its entirety to register your student for Camp 2026.

Cost for Camp is $250 due by Sunday, July 5th. (For families with more than one camper in the same household 2nd, 3rd campers cost $200.)

Payment Options: Once you fill out this form a link will be emailed to you to pay for your student. If you would like to write a check make your check payable to: Horizons Church (Write “Teen Camp” in the memo space.) Please turn check in to Pastor Valarie.

Camp dates: July 12-17

Transportation: We are transporting students to camp on School Buses. They leave July 12th promptly at 2:30pm from Horizons Church.

Students are not allowed to drive to camp.

NOTE: If you have more than one student, you will need to fill out this form for each student individually.
Parent/Guardian Information
Your name

First NameLast Name
Email address
example@example.com
Phone number
Please enter a valid phone number.Format: (000) 000-0000.
Phone type
Student Information
Student's Name

First NameLast Name
Student's Birthday

MonthDayYear
Date
Grade your student FINISHED in June
Student's T-Shirt Size for camp shirt
Does your student have an emergency contact person?
2nd Emergency Contact Name

First NameLast Name
2nd Emergency Contact Number
Please enter a valid phone number.Format: (000) 000-0000.
2nd Emergency Contact Relationship to studnet
Medical Information
Student's Allergies
Please Explain:
Does your student currently suffer from or is being treated for the following:
Should your student's physical activity be limited/restricted for any reason?
Please tell us what restrictions your student must follow.
Is your student currently taking medication?
Please send in containers labeled with name of child and name and dosage of medications and directions for nurse to give to child. The medications will be kept with the nurse. The child will not be allowed to keep medications in their cabin.
Is your student allowed to take Tylenol or Ibuprofen for headache?
Is your student allowed to take TUMS for upset stomach?
Is your student allowed to have cough drops for sore throat or cough?
Does your student have any dietary restrictions?
What is your students dietary restriction?
Optional Waivers For Camp Activities
Waiver For Paint Ball
Would you like your student to participate in Paint Ball?
By signing this I am giving parental permission for my student to use the pain ball equipment.

✱ I will be responsible should my child damage such equipment.
(The equipment is durable. Damage only really results from abuse [throwing, slamming trees, etc....] I will also be responsible for replacing any lost equipment (barrel plugs, squeegees, etc....) based on cost of the new part.

✱ If my child does not follow safety instructions, I will not hold the Paint Ball supplier of the camp staff responsible.
(Safety instructions will be given before the game. Players are responsible to follow all instructions, including the proper use of the safety mask.)

✱ Players who disregard safety rules toward other campers need to realize they may be held responsible.
(for example, the rules state no shooting before the game begins, no shooting at close range)

✱ If my child breaks the rules, I understand they will lose the right to participate further.
(The event will be chaperoned, but, due to the nature of the game, campers are also somewhat on their own. Their cooperation is mandatory.)
Name Of Camper

First NameLast Name
Parent or Guardian Signature
Date

MonthDayYear
Date
Waiver for Tomahawk Axe Throwing
Would you like you student to participate in Tomahawk Axe Throwing?
By signing this, I give permission for my student to take part in a well supervised Tomahawk axe throwing elective at camp.

I understand all reasonable safety precautions will be taken at all times by Horizons Church and its agents during the Tomahawk axe throwing.
Name Of Camper

First NameLast Name
Parent or Guardian Signature
Date

MonthDayYear
Date
Student Agreement

Please read each statement WITH your student. These are the expectations when attending Summer Camp. Please note that we expect all students to abide by these guidelines. Any student choosing not to comply will be asked to return home before camp is complete at your own expense.
I agree not to enter the cabins of the opposite gender.
I understand that during chapel I am expected not to be on my phone, AirPods/headphones, or any other electronic device. *
I agree not to bring or wear inappropriate or immodest clothing.
I agree not to participate in PDA (public displays of affection).
I understand that I am required to follow the schedule and be at all events on time. I understanding that a leader must know where I am at all times.
I will respect all property - both the camp workers and the belongings of other students.
No Pranks.
I understand that campers aren’t allowed the leave the camp grounds.
You are expected to respect all leaders, students, and camp workers.
I understand that if I do not follow these guidelines, there will be consequences for my actions, which could include: sitting out from activities, a call home to my parents, being sent home early, or being excused from future Lift Student Ministries events.
Student Signature
Permission Slip & Medical Release
The following section should be read by parent and filled out accordingly. If you are 18 years old you will need to fill this out personally.
By signing my name below, I confirm I am 18 or older or a parent/guardian granting permission for my student to attend Camp with Lift Student Ministries.
Date

MonthDayYear
Date
Should be Empty:

Lift Student Ministries Camp 2026 Permission & Medical Release Form

Parent/Guardian Information

Student Information

Medical Information

Optional Waivers For Camp Activities

Waiver For Paint Ball

Waiver for Tomahawk Axe Throwing

Student Agreement

Permission Slip & Medical Release