2026 Zion Hill Young Adults
September 11th - 13th 2026 | Ages 18+, $75
Personal Information
Name
*
First Name
Last Name
Gender
*
Please Select
Male
Female
Date of Birth
*
-
Year
-
Month
Day
4 digit year, 2 digit month, 2 digit day
Date
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Amount Owing
Desired Roommate
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Medical Information and Emergency Contacts
Health Card #
*
Family Physician and Phone Number
Medical Aid
*
Please Select
Yes
No
In the case of medical emergency, I understand that effort will be made to contact the primary contact or the emergency contact. In the event they cannot be reached, I hereby give permission for the camp director/designate to sign a consent for medical treatment and to authorize any physician or hospital to provide medical assessment, treatment or procedures for the participant.
Emergency Contact:
*
Medical Conditions
*
None
ADD/ADHD
Behavioural disorder
Convulsions
Asthma
Hearing Problems
Seizures
Diabetes
Other
Do you have allergies or food sensitivities/restrictions?
*
No
Yes, Please fill in details below
Allergies/Sensitivities
*
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Consent and Authorization
Payment Email
example@example.com
I consent to the taking and reasonable use of videos and photography during Zion Hill Camp. I hereby authorize that these may be only used for the following purposes (select all that apply):
*
Email
*
example@example.com
Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Signature
*
YA_Director
*
example@example.com
Submit
Should be Empty: