2019 Hiawatha Youth Camp Registration
Official online registration for the best week(s) of your life! We're excited to have you joining us this summer at HYC. Please fill out all sections of the online form, click SUBMIT, and you'll be officially registered for HYC! SPECIAL NOTE: We're thrilled to have multiple campers from the same family coming to HYC, but you'll need to register each of them separately. Thanks!After submitting your registration, you'll receive an email containing a link to the Hiawatha Paypal payment option. You can pay for your time at HYC online and take advantage of special early registration discount incentives! Please don't hesitate to contact the HYC office with any questions. Call (734) 284-0200 for additional information.
Street Address Line 2
State / Province
Postal / Zip Code
Antigua and Barbuda
Bosnia and Herzegovina
Central African Republic
Cocos (Keeling) Islands
Democratic Republic of the Congo
Turkish Republic of Northern Cyprus
Papua New Guinea
Republic of the Congo
Saint Kitts and Nevis
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Sao Tome and Principe
Trinidad and Tobago
Tristan da Cunha
Turks and Caicos Islands
United Arab Emirates
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Are you coming with a group/ organization?
If yes, what church do you attend?
Who is your Youth Pastor/ Leader?
Emergency Contact Information
Please enter the name of the parent or guardian who should be contacted in the case of an emergency.
Relationship to Camper
EMERGENCY CONTACT PHONE #1
EMERGENCY CONTACT PHONE #2
Help us to help you have a wonderful time at HYC!
Choose Your Week(s) at HYC! (JULY TEEN WEEK 2
June 24 - June 28 | Junior Camp | Rebecca Adkins
June 30 - July 5 | Middle School | Nick Barker
July 7 - July 12 | Teen Week 1 | Leo Robinson II
July 21 - July 26 | Teen Week 3 | Scott Crownover
August 1-4 | Young Adult Retreat | Cory Nederveld
If you selected the $50 deposit option, please select which week you are registering for.
Middle School Week
Teen Week 1
Teen Week 2
Teen Week 3
Young Adult Retreat
Roomie Request: (Just a request, not a guarantee)
Friend Referral: (Let us know who invited you so we can thank them!)
HYC BUS TRANSPORTATION
Bus transportation from West Branch, MI is available for campers needing help getting to HYC. We're blessed to have Trinity Transportation of Wyandotte, MI as the Official Transportation Provider of HYC!Details:HYC will pick up and drop off campers at Exit 212 in the Burger King Parking Lot located at 2925 Cook Rd. A Hiawatha Staff Representative will accompany campers to and from West Branch. Campers returning from HYC will have the opportunity of eating at Burger King upon their arrival that day. (Please make sure that they have $$$ for lunch!)FOR TEEN WEEKS 1, 2, 3 - SUNDAY is the beginning of your camp week and SATURDAY is the end. This is ALL NEW for HYC, so please make note of the change!* Transportation details will be emailed to all campers registering for HYC transportation
Do you need bus transportation to/ from HYC?
HYC CAMPER MEDICAL INFORMATION
The following information is requested so that Hiawatha Youth Camp can best meet the physical, intellectual and emotional needs that may occur over the course of the summer.Per State of Michigan requirements, please fill out all information requested. Thank you!
Camper Medical History- Does the camper experience any of the following?
Hay fever, asthma, or wheezing
Eczema or frequent skin rashes
Frequent colds, sore throats, ear aches (4 or more per year)
Allergies (including food and medications)
Trouble with passing urine or bowel movements
Shortness of breath
Has girl been told about menstruation?
Should activity be restricted because of physical limitation or illness?
Please explain any areas identified above:
Operations or pre-existing injuries:
Please provide details any regarding Health, Emotional or Behavioral issues that HYC should be aware of:
Does Camper require administration of medication?:
Are Camper's immunizations up to date?
CAMPER INSURANCE INFORMATION
In Case of an Emergency
Health Insurance Company
Policy/ Account #
I hereby give permission for routine health care provided by Hiawatha Youth Camp, and in case of emergency, to the licensed physician selected by the camp to hospitalize, secure proper treatment, and authorize anesthesia or surgery for the child named on this form.
I hereby give permission to Hiawatha Youth Camp to transport the child named on this form off of the camp premises for purposes of field trip activities.
I hereby give permission to Hiawatha Youth Camp to use photos/videos of the child named on this form for the purposes of promoting the camp, and waive all claims to compensation for the use of his/her likeness.
Please type name of Parent/ Guardian granting permission.
CAMPER PAYMENT INFORMATION
HYC strives to keep camper costs low so that no one is unable to attend due to financial constraints. If you have financial need, please contact the HYC office right away to request financial aid information.When you SUBMIT this form, you'll be directed to:http://hiawathayouthcamp.com/payment.htmFrom there, you'll be able to officially select your date(s), transportation option, finalize payment, and be officially registered for HYC!
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