Camper Registration

1Camper/Parent Agreement

2Camper Information

3Medical Information

4Parent Information

5Payment Information

I, the camper, am aware of the camp policies and guidelines. I understand that this is a church related camp and that certain standards of conduct will be required of the camper. If accepted, I agree to abide by the camp rules. I agree to demonstrate respect for the camp staff at all times. I understand that if I fail to keep my agreement, I may be asked to leave camp. I give permission to use pictures in which I may appear in camp brochures, flyers or other promotional literature both electronic or published and used by the camp.
Campers Name*
First Last
Camp Week*
Please choose what week the camper will be attending. This is based on what grade the camper will be in when they start school in the Fall of 2023.
Gender*
- Male
- Female
Grade by Camp*
Camper T-Shirt Size*
This year a t-shirt is included in the registration fee. Please let us know what size your camper wears.
Canteen Card*
This year a canteen card is included in your registration fee. Elementary Week #1 (K-2nd) will receive a $10.00 canteen card and all other weeks will receive a $20.00 canteen card. If your child has any money left after their camp week, please indicate what you would like us to do with the remaining balance.
- I would like to donate the remaining balance to future CYC projects.
- I would like to be refunded the balance, only if my camper has $7.00 or more left on his/her canteen card.
- I would like to be refunded the full remaining balance that is left on my campers canteen card.
Birthdate*
MM slash DD slash YYYY
Age During Camp*
Room Request*
Please list any room request in this area.
Church Name*
What city is your church located in?*
Pastor's Name*
As parent/guardian, I have read the Camp Policies and Guidelines and have reviewed them with my child. I accept them and expect my child to abide by them. I will be responsible for any and all property damaged by my child when he/she is at camp. I also understand that CYC provides secondary insurance coverage and will not be liable for any expenses beyond that which is covered by insurance. In case of a simple accident or illness, the camp director may make necessary arrangements. If the accident or illness is serious, I request the camp director to take all necessary steps to insure my child’s health. I give permission to use pictures of my child (as a camper) which may appear in camp brochures, flyers, or other promotional literature—both electronic or published and used by the camp.
Parent/Guardian Name*
First Last
Parent/Guardian Signature*
Use your mouse to draw your signature.
Date*
MM slash DD slash YYYY

Mailing Address*
Street Address City State ZIP Code
Phone*
Email

Consent*
I have read and agree the visitor policy.
VISITORS:
For the safety of our campers, staff and volunteers - no visitors will be allowed on CYC campus during camp weeks.

1. We will operate within a “camp bubble” this camp season, this strictly limits visitors on camp property.
2. Visitors will not be allowed on camp property at any time during the summer. This includes parents, friends, pastors, or anyone who is not approved. Essential visitors, such as food delivery, plumbers, electricians, etc. will be allowed on camp property and maintain social distancing standards.
3. If for any reason a visitor needs to come on campus, he/she must be approved by the Camp Director before being allowed on camp property.
Consent*
I agree to the photo/video release agreement below.
I grant permission to Crusader Youth Camp & the PFWB Orginization, its agents, and its employees the irrevocable and unrestricted right to produce photographs and video taken of my child, myself, and members of my family while at Crusader Youth Camp for any lawful purpose including publication, promotion, illustration, advertising, trade, or historical archive in any manner. I hereby release Crusader Youth Camp and its legal representatives from liability for any violation or claims relating to said images or video. Furthermore, I grant permission to use the statements of my child, myself, or my family members given during an interview or evaluation with or without my name for the purpose of advertising and publicity without restriction to time limit or geographic area. I waive my right, my child’s rights, and my family’s rights to any and all compensation stemming from the use of these materials.”

Parent/Guardian Information*
Please list at least one parent/guardian for us to contact if needed.
Name Home Phone Cell Phone Email
Emergency Contact Name*
In the event of an emergency, the parent above will be notified first. Please list an additional emergency contact person, incase we are unable to reach the parent listed above.
Phone Number*
Relationship to Camper*
Who will be picking your child up on Friday?*
PLEASE NOTIFY THE CAMP DIRECTOR IF THIS CHANGES.
Camper Signature*
Use your mouse to draw your signature.
Parent/Guardian Signature*
Use your mouse to draw your signature.

Please choose the week of camp attending:*
See top of page for dates.
Payment Options*
Please know that if you choose "Bill to My Church", we will contact the pastor/youth pastor of that church to verify that they will pay for you/your child to attend. If your church declines payment, then you are responsible for the full registration fee.
To pay at check-in, use the code CHECKIN; To bill a church, use the code CHURCH
Church Name to Bill*
Online Processing Fees*
Price: $0.00
Total
$0.00
Credit Card
Card Details
Cardholder Name

Name	Home Phone	Cell Phone	Email

WE ARE EXCITED TO SEE YOU IN 2023!