Central District Midwinter Camp 2027

Central District Midwinter Camp 2027
MIDWINTER BASICS

Who: Students 6th-12th grade and their adult leaders

When: January 22-24th, 2027

Where: HEB Camp (Leakey, TX map)

Deadline to Register: December 31, 2026 11:59PM

Need help registering? Contact Katie Myers, Camp Registrar, by email youth@mylhumc.org
Participant Name

First NameLast Name
Church Group (Church Name, City)
Participant Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
T-shirt Size
Gender
For use in making cabin assignments.
Are you an adult or student participant?

Adult Participant
Are you Safe Gatherings Certified?
IF YOU ARE NOT SAFE GATHERING CERTIFIED YOU MUST BECOME CERTFIED BEFORE CAMP OR YOU WILL NOT BE ALLOWED TO ATTEND.

Please use this link to begin certification. https://safegatherings.com/app/login/new-user
All adut leaders will have responsibilities during Winter Camp. This may include one or more of the following:
- cabin counselor
- small group leader
- photography
- assisting with activities
- set-up and clean-up
- serving in worship
- other duties as assigned
Please share with us any special skills you would like to offer to the camp leadership team.
Please share any restrictions that you have that might impact your ability to undertake particular tasks at camp.
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com

Student Participant
Preferred Name (for nametag)
Current Grade in School
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Parent Name

First NameLast Name
Parent Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent Email Address
example@example.com

Emergency Contacts
Emergency Contact Name 1

First NameLast Name
Emergency Contact 1 Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Relationship to Participant
Emergency Contact Name 2

First NameLast Name
Emergency Contact 2 Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Relationship to Participant

Medical Information

For uninsured individuals, enter “N/A” for the alpha responses and “0000000000” for the numeric responses. Upload a blank document for the insurance card photos.
Primary Care Physician
Primary Care Physician Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Front of Your Insurance Card

Cancelof
Back of Your Insurance Card

Cancelof
Current Medications?
Any Health Concerns?
Dietary Restrictions?
Allergies?

Camp Covenant
All adult and student participants must sign this document.

Parents, please read and review this covenant with your student carefully.
Student/ Adult Participant Signature
Parent Signature

H.E. Butt Foundation Liability Waiver

All participants must bring a completed waiver with them to camp.
Signature

Release Forms
I, the undersigned, do hereby attest that all the information on this form concerning my child (the above named “Student Participant”) or myself (the above named "Adult Participant") is the most current available. For Student Participants below the age of 18, I, the parent/guardian of the above, give my permission for the Participant to participate in the activities of the Central District of the Rio Texas Conference of the United Methodist Church (“Central District”). This includes all sponsored activities on or off the premises of H.E. Butt Foundation Camp, including any and all activities involving travel and/or lodging. This permission shall remain in effect until January 25, 2027 unless terminated in writing.
I hereby authorize the Central District and the adult leaders from its participating churches serving as ministry staff to administer the medications as listed above. In order for my child/myself to receive necessary medical treatment from medical staff and/or physicians in a medical clinic or hospital in case of illness or injury, I hereby consent to and authorize the ministry staff to obtain and consent to medical treatment for such illness or injury during the activity or activities of the Central District. It is understood that this authorization and consent is given in advance of any specific diagnosis or treatment and is given to encourage those persons who have temporary custody of the Participant, in my absence, and medical staff to exercise their best judgment as to the requirements of such diagnosis or said medical treatment. This medical consent will remain effective until January 25, 2027. I understand that any and all medical expenses incurred are my responsibility.
I hereby give my permission for the Participant to be transported in any vehicle designated by any ministry leader designated by the Central District, and in whose care the Participant has been entrusted while attending and participating in an activity or activities of insert the Central District.
In consideration of the Central District here allowing my child/myself to participate in activities referenced above, I agree to release and hold harmless the Central District, its officers, agents and/or designated leadership, from any liability to or responsibility for bodily injury, damage, or illness to my child/myself while participating in any youth athletic or social activity which may be directly or indirectly sponsored by the Central District. Further, I agree to indemnify and hold harmless the Central District, its officers, agents and/or designated leadership with respect to any claim asserted by or on behalf of my child/myself as a result of bodily injury, illness, or damage.
The Central District and its participating churches might use any still and/or moving image (video footage, photographs, and/or audio footage) on the district and/or church’s website, social media groups, or other online and/or printed publications without further consideration. The Central District and its participating churches have the right to alter the photograph(s) at their discretion. The Central District and its participating churches may choose not to use my photograph(s) at this time, but may do so at a later date, up to 2 years from the date of the photograph was taken. Once an image is posted on the website or other online platform, the image can be downloaded by any computer user, anywhere in the world. The Central District and its participating churches commit to eliminating any identifying information including name and age from the publication.
Consent and Signature
Signature
Should be Empty:

Central District Midwinter Camp 2027

Adult Participant

Student Participant

Emergency Contacts

Medical Information

Camp Covenant

H.E. Butt Foundation Liability Waiver

Release Forms