• Virginia District Youth Camp

    Student Application

    Student Conduct Guidelines

    1. Campers are not allowed to leave the grounds without permission from the Youth President or his delegated representative.
    2. Concerning physical conduct of campers- public displays of affections such as kissing, hugging, holding hands, or any other action not conducive will not be allowed.
    3. All campers are required to wear their registration band at all times excluding times of recreation.
    4. Campers are NEVER ALLOWED to enter the dorm room of the opposite gender. 
    5. Youth Camp is a time designated for students to draw closer to God & with other Apostolic students therefore, no camper shall have in their possession at any time: knives, guns, weapons, fireworks, drugs, drug paraphernalia, tobacco products, and/or alcoholic beverages.
    6. Vile, rude or profane language is prohibited.
    7. All students should give respect to the campground buildings and facilities.
    8. The Barracks & Davis buildings are off limits at all times.
    9. Only registered campers will be allowed on campus during daytime activities. Evening services are open to everyone.
    10. Students are required to attend all classes and services as outlined on the camp.
    11. Students must show respect to staff and instructors. 
    12. Use of cell phones within the dormitories including photography, videography, video messaging, social media, is ABSOLUTELY PROHIBITED. Texting and calling within the dormitories will be allowed within the assigned open dorm timeframe on the VDYM Youth Camp Schedule. Use of a cell phone for any reason within the bathrooms is ABSOLUTELY PROHIBITED.

    Student Dress Guidelines

    1. No shorts allowed. Wind pants, slacks, & jeans for boys; dresses or skirts that cover the knee for girls. Please remember that the skirt is only as long as the slit is high.
    2. Swimwear is appropriate in the pool area only, and during the designated separated swim time for boys and girls.
    3. No ornamental jewelry (necklaces, body piercings, earrings, rings, bracelets, etc.).
    4. No vulgar or inappropriate slogans on clothing.
    5. No makeup shall be worn at any time.
    6. Please wear clothes that fit modestly (No tight or see through clothing, no tank tops, proper necklines).

  • Student Information

  • Which youth camp is this for?*
  • Date of Birth*
     / /

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  • Parent/Guardian Information

  • Do you share the same address as the student?*
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.

  • Medical Information

  • Additional contact in the event parent(s)/guardian(s) cannot be reached.

  • Format: (000) 000-0000.
  • What type of allergies does the student have?*
  • Diet & Nutrition*
  • Physical Activity Restriction*

  • Medical Insurance Information

  • This student is covered by medical/hospital insurance*
  • Format: (000) 000-0000.
  • Medication Requirements*

  • "Medication" is any substance a person takes to maintain and/or improve their health. This includes vitamins & natural remedies. Original pharmacy containers with labels which show the camper's name and how the medication should be given are required. Provide enough of each medication to last the entire time the camper will be at camp.

     

  • Rows
  • Is your child able to self-administer their own medication(s)?

  • Parent/Guardian Authorization for Health Care: This health history is correct and accurately reflects the health status of the camper to whom it pertains. The person described has permission to participate in all camp activities except as noted by me and/or an examining physician. | give permission to the physician selected by the camp to order x-rays, routine tests, and treatment related to the health of my child for both routine health care and in emergency situations. If I cannot be reached in an emergency, I give my permission to the physician to hospitalize, secure proper treatment for, and order injection, anesthesia, or surgery for this child. I understand the information on this form will be shared on a "need to know" basis with camp staff. I give permission to photocopy this form. In addition, the camp has permission to obtain a copy of my child's health record from providers who treat my child and these providers may talk with the program's staff about my child's health status.

  • Date*
     / /

  • Parent/Guardian Authorization for the Administration of OTC Medications: The following non-prescription medications may be stocked in the camp health center and are used on an as needed basis to manage illness and injury. 

     

  • Please check any medication the camper SHOULD NOT be given.
  • Date*
     / /

  • Parental Consent

  • By signing below I verify, that  I understand: (1) I will be held responsible for the cost of any damage caused by my camper; and (2) I will be responsible to provide transportation home if my camper is dismissed early for misbehavior. I have read the camp rules and will support the Virginia District UPCI Youth Department in enforcing these rules. I have read and signed the Guidelines, Policies, Consent and Release forms and hereby reaffirm VA District UPCI, their agents and representatives (including camp staff) from all liability thereof and claims arising out of my campers' attending and/ or participating in camp. I further understand that from time to time VA UPCI promotions and other campers may take photographs or films during camp activities and that such photographs may appear in various promotional materials, newsletters, websites, advertisements, or presentations, therefore I consent to the use thereof.

    I have carefully read and understand the above provisions and agree to them.

  • Date*
     / /

  • Student Agreement

  • By signing below, I verify that I (the student) have read the camp rules and will comply with the Virginia District UPCI Youth Department in adhering to these rules. I have read and understood the Guidelines, Policies. I also understand that failure to comply with the guidelines and policies listed in the student application could result in my immediate dismissal from camp. I further understand that from time to time VA UPCI promotions and other campers may take photographs or films during camp activities and that such photographs may appear in various promotional materials, newsletters, websites, advertisements, or presentations, therefore I consent to the use thereof.

    I have carefully read and understand the above provisions and agree to them.

  • Date*
     / /

  • Pastoral Permission

  • This application is for {name} to attend {whichYouth}.

    If you would like to approve their student camp application, please sign and date the form. Once finished, you can click submit and the process will be complete. Thank you!

  • I give my pastoral permission for the student that has signed this application to attend Youth Camp. I understand that the Executive Youth Camp Committee [Youth President, Youth Secretary, and District Superintendent] may need to contact me in the event of an emergency or if the camper violates the camp guidelines and/or policies.

  • Date*
     / /
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  • Should be Empty: