Summer Registration

Youth Camp Out 2026

June 27 – July 1 · Elks Group Campground

Please complete one form per student. A parent or guardian should fill out this form.

Student Information

Basic details for the camper attending camp.

Student Full Name *

Preferred Name

Age *

Date of Birth *

Grade Completed

Gender

Parent / Guardian Information

The primary contact for camp communication and emergencies.

Parent / Guardian Name *

Relationship to Student

Parent / Guardian Phone *

Parent / Guardian Email *

Home Address

Emergency Contact

Someone who can be reached during camp if needed.

Emergency Contact Name *

Emergency Contact Phone *

Relationship

Medical and Camp Details

Help us care for your student well while at camp.

Medical Conditions, Allergies, Medications, or Dietary Needs

Additional Notes or Special Instructions

Permissions and Waiver

Please read carefully and confirm each item below.

I give permission for my student to attend Youth Camp Out 2026. I understand that camp activities may include transportation, hiking, games, outdoor activities, campfire activities, and other group events. I understand that reasonable precautions will be taken for safety, but I also recognize that participation in camp involves inherent risks.

In the event of illness or injury, I authorize camp leaders, volunteers, and event staff to secure appropriate medical treatment for my student if I cannot be reached promptly. I understand that I am responsible for any medical expenses incurred.

I certify that the information provided on this form is accurate to the best of my knowledge, including any medical, allergy, medication, or behavioral information that camp leaders should know in order to care for my student responsibly.

I give permission for photos or videos of my student to be used for church or youth group communication. I give permission for my student to be transported as needed for camp-related activities. * I authorize emergency medical care if I cannot be reached immediately. * I have read and agree to the waiver and release above. *

Parent / Guardian Full Name (Digital Signature) *

Date Signed *

Fields marked with * are required.