• Maysville Wesleyan Youth Camp June 22-26, 2026 Location: Maysville Campgrounds, 8682 Mason-Lewis Rd, Maysville, KY

    Preregistration is Highly Recommended
  • NOTE: All information is kept confidential and is only available to camp administrators and, if necessary, medical providers.

  • COST is $175.00 per camper. Make checks payable to Maysville Wesleyan Youth Camp. Mail checks to Michael Schwind, 9611 Harrodsburg, Rd., Wilmore, KY 40390

  • *Please fill out this form in entirety for each camper.*

  • Format: (000) 000-0000.
  • Gender*
  • Grade*
  • T-Shirt Size
  • Family Information

  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Health Insurance / Physician Info

    Please provide as much information as possible.
  • Format: (000) 000-0000.
  • Medical Info / Release Form

    The medical questions below serve as the camper's medical release form. Campers and parents must complete the form for each participant in order to attend Maysville Wesleyan Youth Camp.
  • Allergies:*
  • Diet / Nutrition:
  • Restrictions (asthma, diabetes, disabilities, etc.):
  • Immunizations up-to-date?
  • Please check the medications listed below which you authorize staff to give camper while at camp (if needed).  If permission is not granted for a particular medication, please leave that one blank. To authorize all medications on this list please check the first box.*
  • Please check all that apply. Has this camper...
  • Has this camper had problems with periods / menstruation?
  • Please check all that apply. Within the last year, has this camper...
  • Immunization: If my camper has not been fully immunized, I understand and accept the risks to my child from not being fully immunized.

    Emergency Authorization: I hereby give permission to medical personnel selected by the participant s Church sponsor/his designee or camp staff to order X-rays, routine tests, and treatment for myself. In the event of an emergency and neither my primary contact nor secondary can be reached, I hereby give permission to the physician selected by the Authorized Agent to hospitalize, secure proper treatment, order injections and/or anesthesia and/or surgery to myself as named above. I further authorize the release of the above medical information to appropriate medical personnel and/or the health coverage insurance company. In addition, I have, and do hereby, release the church, its employees or agents from liability associated with participation in a church activity. I understand that if I do not have medical insurance, I, as the parent or guardian, will be responsible for any medical expenses in the event of a sickness and/or injury.  I understand that there are risks involved in taking place in recreation activities and other activities related to participation in youth functions.

    Photo Release: With participation, I give permission for myself/my child to be photographed, and/or videotaped while participating in the above stated camp/retreat for the purposes of publicity, staff training, and/or promotion.

  • NOTE: Any/all medications that are brought to camp MUST be turned in to the camp nurse during a minor’s stay. No student/minor may be allowed to keep any prescription drugs and/or over-the-counter medications in their possession at any time.

  • I certify that the information described above is accurate and complete to the best of my knowledge.  I give permission for the child(ren) listed above to attend the Maysville Wesleyan Youth Camp.

    I also certify that I have read the CODE OF CONDUCT and have gone over it with the camper and he/she and I agree to adhere to it.  Copies are available by emailing steverwill@gmail.com

  • CODE OF CONDUCT--Upon receiving your registration, you will receive an email from the director, Steven Willingham, with a copy of the Code of Conduct. The form is to be printed, read over together, and signed by BOTH the camper and parent/guardian and brought to registration at camp. There is also an additional MEDICAL RELEASE FORM to be signed by the parent/guardian.

  • Should be Empty: