Please read this entire message carefully.

There is a packet available for download in the link below — please read it thoroughly, but do NOT complete the printed version.

Instead, fill out the digital version located on this page.

Once everything is submitted online, we’ll have you sign the documents in person at youth.

packet Download link

Digital Youth Camp
Registration Form

Name

First Name

Last Name

Gender

Birthdate

YYYY

Grade (24' - 25' school year)

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Home Phone

(###)

###

####

Father's Name

First Name

Last Name

Father's Phone

(###)

###

####

Mother's Name

First Name

Last Name

Mother's Phone

(###)

###

####

Emergency Contact (If unable to reach parents during camp)

First Name

Last Name

Relationship

Phone

(###)

###

####

Insurance Carrier

Insurance Phone #

Policy #

Group #

Insured’s Name

First Name

Last Name

Current Immunizations

If no, what is missing

Inhaler

Epi-pen

Exposed to a communicable disease

Physical needs that would limit camp activities

Can student swim

Can student use shallow end

Allergic to

Can students be given Ibuprofen, Tylenol, or Benadryl if needed?

List ALL MEDICATIONS that student is currently taking

Is there any information that we should have regarding the welfare of this camper?

Please read this entire message carefully.

Digital Youth Camp Registration Form

Digital Youth Camp
Registration Form