Camp Registration

1
Date* This field is required.
Date
Year
Month
Day
2
Are you a student, chaperone, staff* This field is required.The staff designation is for adults attending camp to help in a specific role not related to a church
Student
Chaperone
Staff
3
Which Camp?* This field is required.Which camp will you be attending? High School Camp: June 2-6, 2025 Middle School Camp: June 9-13, 2025
High School Camp
Middle School Camp
4
At which camp will you be a chaperone?* This field is required.Which camp will you be attending? High School Camp: June 2-6, 2025 Middle School Camp: June 9-13, 2025
High School Camp
Middle School Camp
Both Camps
5
Your Name* This field is required.Please enter the name of the person attending camp
First Name
Last Name
6
Birthday* This field is required.
Date
Month
Day
Year
7
Address* This field is required.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
8
Cell Phone
Please enter a valid phone number.
9
Your Email* This field is required.
example@example.com
10
Gender* This field is required.
Male
Female
11
Shirt Size* This field is required.
Small
Medium
Large
XL
2X
3X
4X
5X
12
Please list any medical problemsmake a list separated by commas. i.e./ asthma, diabetes or enter NA
13
Please list any dietary restrictionsMake a list separated by comas: i.e. gluten free, Vegan,
14
Do you have any allergies
YESNO
15
Food allergies?make a list separated by commas. i.e./ peanuts, shellfish or enter NA
16
Please list any allergiesmake a list separated by commas. i.e./ peanuts, penicillin or enter NA
17
Please list past surgeriesmake a list separated by commas. i.e./ knee replacement, brain replacement or enter NA
18
Please list any medications and dosage you will be taking* This field is required.make a list separated by commas. i.e./ prednisolone 25mg, ritalin 20mg or enter NA
Huge
Large
Normal
Small
Ok
Ok
19
Contact Person* This field is required.
First Name
Last Name
20
Home Phone
Please enter a valid phone number.
21
Work Phone
Please enter a valid phone number.
22
Contact Phone* This field is required.
Please enter a valid phone number.
23
Insurance Company* This field is required.
24
Policy Number #* This field is required.
25
What church are you a part of?* This field is required.
Please Select
Please Select
Ashland City Faith Community
Bell Road
Bent Knee Cowboy
Body of Christ
Bread of Life Community
Bridge Point
Brookhaven First
Clarksdale
Clarksville First Community of Hope
Clarksville Grace
Clarksville Hope Riders Biker Church
Cleveland First
Columbia First
Columbia Grace
Columbus First
Community Fellowship
Concord Community
Covington
Crossroads
Crossroads Community
Crystal Springs
DaySpring Community
Dickson Lighthouse
Donelson
Dover
Elmore
Erin
Fellowship
Fly
Foundry
Franklin Community Faith
Fulton First
Gallatin First
Gateway Community
Glencliff Hispanic
Gloster
Goodlettsville
Gray's Chapel
Grenada First
Griffin's Chapel
Gulf Coast Family
Harmony
Hattiesburg First
Hazkehurst
Hendersonville
Hermitage
Highland
Hillside Community
Igelsia Del Nazareno Eben-Ezer
Igelsia Hispana Betel de Gallatin
Jason Chapel
Joelton
Jones Chapel
Kingston Springs
Laurel Bresee
Laurel First
Lewisburg First
Libertad en Cristo
Lifepointe Community
Long Creek
Madison
Madison Hispanic
Magnolia
Memphis Calvary
Memphis Eastside
Memphis Emmanuel
Memphis Friendship
Memphis Grace
Memphis Holiness Tabernacle
Memphis Hope Tabernacle
Memphis Refreshing Springs
Meridian Fitkins Memorial
Meridian Northside
Millington
Mount Wesley-Akin Chapel
Nashville Blakemore
Nashville Christ
Nashville First (Main Campus)
Nashville First (Bethel Campus)
Nashville First (Calvary) Korean
Nashville Grace
Nashville Inglewood
Nashville Kaleo
Nashville Trinity
New Albany First
New Vision
Old Hickory
Oxford
Palabra de Vida
Paris
Park Lane
Pearson Chapel
Pine Hill
Pleasant Point
Portland
Prentiss
Quitman
Ripley Hispanic
Rosebloom
Savannah
Sentobia N.O. Nabors Memorial
Spring Hill Restoration Community
Springfield First
Starkville Wesley Community
Trevecca Community
Union
Vicksburg First/Vicksburg Hispanic
Victory Praise and Worship Center
Waverly
Way of the Cross
Waynesboro Trinity
Westwind Community of Faith
White House
Woodlawn Community
Individual - No church affiliation
Other
26
Who is your youth leader/pastor* This field is required.
First Name
Last Name
27
What is your youth leader/pastor's email?* This field is required.
example@example.com
28
Will your youth leader be attending camp?We understand that not every youth leader is able to attend camp and we don't want you to be left out. Please let us know if your youth leader will be attending your camp.
YESNO
29
Is there another church that you would like to room withDue to limited space, we will not be able to accommodate every request. However, we will do our best to make it happen.
Ashland City Faith Community
Bell Road
Bent Knee Cowboy
Body of Christ
Bread of Life Community
Bridge Point
Brookhaven First
Clarksdale
Clarksville First Community of Hope
Clarksville Grace
Clarksville Hope Riders Biker Church
Cleveland First
Columbia First
Columbia Grace
Columbus First
Community Fellowship
Concord Community
Covington
Crossroads
Crossroads Community
Crystal Springs
DaySpring Community
Dickson Lighthouse
Donelson
Dover
Elmore
Erin
Fellowship
Fly
Foundry
Franklin Community Faith
Fulton First
Gallatin First
Gateway Community
Glencliff Hispanic
Gloster
Goodlettsville
Gray's Chapel
Grenada First
Griffin's Chapel
Gulf Coast Family
Harmony
Hattiesburg First
Hazkehurst
Hendersonville
Hermitage
Highland
Hillside Community
Igelsia Del Nazareno Eben-Ezer
Igelsia Hispana Betel de Gallatin
Jason Chapel
Joelton
Jones Chapel
Kingston Springs
Laurel Bresee
Laurel First
Lewisburg First
Libertad en Cristo
Lifepointe Community
Long Creek
Madison
Madison Hispanic
Magnolia
Memphis Calvary
Memphis Eastside
Memphis Emmanuel
Memphis Friendship
Memphis Grace
Memphis Holiness Tabernacle
Memphis Hope Tabernacle
Memphis Refreshing Springs
Meridian Fitkins Memorial
Meridian Northside
Millington
Mount Wesley-Akin Chapel
Nashville Blakemore
Nashville Christ
Nashville First (Main Campus)
Nashville First (Bethel Campus)
Nashville First (Calvary) Korean
Nashville Grace
Nashville Inglewood
Nashville Kaleo
Nashville Trinity
New Albany First
New Vision
Old Hickory
Oxford
Palabra de Vida
Paris
Park Lane
Pearson Chapel
Pine Hill
Pleasant Point
Portland
Prentiss
Quitman
Ripley Hispanic
Rosebloom
Savannah
Sentobia N.O. Nabors Memorial
Spring Hill Restoration Community
Springfield First
Starkville Wesley Community
Trevecca Community
Union
Vicksburg First/Vicksburg Hispanic
Victory Praise and Worship Center
Waverly
Way of the Cross
Waynesboro Trinity
Westwind Community of Faith
Woodlawn Community
30
Have you ever been convicted, entered a plea of guilty or no contest to any crime other than a minor traffic violation?* This field is required.
YESNO
31
Please explain including the date, jurisdiction, and details
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Large
Normal
Small
Ok
Ok
32
Are you under investigation by or have you ever been reported to Child Protective Services (or any equivalent agency in any jurisdiction) for child abuse, neglect, or any criminal activity involving a minor?* This field is required.
YESNO
33
Please explain including the date, jurisdiction, and detail
Huge
Large
Normal
Small
Ok
Ok
34
Have you ever been charged with or accused of sexual harassment?* This field is required.
YESNO
35
Please explain including date and details
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Large
Normal
Small
Ok
Ok
36
Statement of Faith* This field is required.Please describe your current walk with Christ and how you came to know the Lord.
Huge
Large
Normal
Small
Ok
Ok
37
Why do you want to be a camp counselor?* This field is required.
Huge
Large
Normal
Small
Ok
Ok
38
Counselor Signature* This field is required.I certify that the information I have provided is true. I release and hold harmless from all liability any individual or entity requesting or supplying information with respect to my application for volunteer work. I understand if my application is approved I will be attending camp as a leader and worker. I agree to cooperate with NYI leadership and be respectful of its decisions. I further agree to abide by and enforce camp expectations as I represent Christ to the students with which I will attend camp.
Clear
39
Do you want to pay online?* This field is required.If you want to pay online you will have to submit the full payment amount. If your church has a price different than the current prices please click no and submit your form. Regardless of current payment, please make sure finish the form and to hit submit at the end. If you do not hit the submit button your registration will not be submitted! We can't wait to see you at camp.
YESNO
40
PaymentPlease remit payment in the full price of Camp @ the Creek 2025. If your youth leader/pastor has given you a church rate code, please enter it below, this will allow you to pay your portion of the camp registration price and your church will be responsible for the rest.
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ORDER SUMMARY
Total costUSD
Late Registration
$300.00Edit
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Chaperone One CampPlease select this option if you are going to be a chaperone for EITHER Middle High OR Senior High Camp
$150.00Edit
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Chaperone Both CampsPlease select this option if you are going to be a chaperone at BOTH Middle High and Senior High Camps
$250.00Edit
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Total cost $0.00
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