"Lost In Translation" HYM Camp 2026

HYM Camp Registration Form

This application is for campers aged 15-35, and each church group is required to provide 1 chaperone for boys and 1 for girls. Chaperon MUST be over the age of 25 yrs. Please note that accommodations are in shared spaces, and you may be asked to share a bed at the hotel lodge. *HOW TO PAY: JOT FORM PAYMENT MUST BE DONE BY CREDIT CARD.... IF YOU WOULD LIKE TO PAY WITH CHURCH CHECK YOU CAN, PLEASE DELIVER TO THE SOUTHERN CALIFORNIA CONFERENCE, HISPANIC REGIONAL OFFICE, TO LUZ BENITEZ. MAKE PAYMENT TO “Southern California Conference” In the Memo write: "HYM Camp" ((NO PERSONAL CHECKS/ NO CASH/ NO REFUNDS)) APPLICATIONS ARE NON-TRANSFERABLE. NO EXCEPTIONS.
HYM CAMP September 4th - September 7th, 2026

Location: 39850 CA-38, Angelus Oaks, CA 92305 // Phone: (909) 794-2911
Pacific Union Conference: Which Conference are you from?

Other
Full Name

First NameMiddle NameLast Name
Birth Date

MonthDayYear
Age
Gender
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
E-mail
example@example.com
Mobile Number
Format: (000) 000-0000.
Baptized
Church Name
AY Director / Youth Director

First NameLast NameAge
AY Director / Youth Director Mobile Number
Format: (000) 000-0000.
Pastor of Local Church
1st Elder of Local Church
Pastor Mobile Number
Format: (000) 000-0000.
1st Elder Mobile Number
Format: (000) 000-0000.
Pastor Signature
1st Elder Signature
*Acepto las reglas y condiciones del campamento
I am the Chaperone (I Understand I will stay with the campers I am assigned to at all times)
Male Chaperone Name (Must stay with the campers they are assigned to at all times)

First NameLast NameAge
Chaperone for
Mobile Number
Format: (000) 000-0000.
Female Chaperone Name (Must stay with the campers they are assigned to at all times)

First NameLast NameAge
Chaperone for
Mobile Number
Format: (000) 000-0000.

Emergency Contact:

Rows	Name	Relationship	Phone Number
Person #1
Person #2

Medical Information: If any medical conditions such as: diabetes, high blood pressure, recent surgery, organ transplant, asthma, heart problems, epilepsy, etc. and/or any allergies (if severe, please be sure to bring an EpiPen & or any prescribed medications), please list below:
Dietary Preferences
Tshirt size: SUPPLIES LIMITED
Liability: I understand that photography and video may occur during the event. I consent (*for my child) to such recording media and its release for promotional purposes by HYM / FJA. Campers with any medical conditions are responsible for bringing their medication. HYM / FJA are not responsible for any medication forgotten by the camper. I authorize (*my son/daughter) to be treated in case of a medical emergency. I also understand that I am responsible for any consequences due to actions or conduct that may be detrimental to this event. I certify that I am at least 18 years of age or that I am the camper’s parent/guardian. I have read the regulations and rules for camp. ((See Website for Rules))
Camper's Signature (Parents / Guardians Signature if Camper is 15 -17 yr of age)
Local Church Financial Assistance
Is Your church helping you financially? Talk to your local church pastor or youth leader.
Local Church Financial Assistance Amount $$ (**If applicable**)
** Interested applicants pay their portion directly to the church. The church adds its financial assistance contribution to that amount, then sends one combined check to the Southern California Conference, Hispanic Region Office, covering both the applicant's payment and the church's assistance.**

Camp Stay:

Hotel (Lodge)

Enter description

$250.00 Quantity

Cabin

$165.00 Quantity

Total

Debit or Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year

Should be Empty:

HYM Camp Registration Form

HYM CAMP September 4th - September 7th, 2026

Camp Stay: