Camper Registration - Crusader Youth Camp

1 Camper/Parent Agreement

2 Camper Information

3 Medical Information

4 Parent Information

5 Payment 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.
Camper Signature*
Use your mouse to draw your signature.
Church Name*
Room Request*
Please list any room request in this area.
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 Signature*
Use your mouse to draw your signature.
Date*
Date Format: MM slash DD slash YYYY

Name*
First Last
Mailing Address*
Street Address City State ZIP Code
Phone*
Email
Birthdate*
Date Format: MM slash DD slash YYYY
Age During Camp*
Grade by Camp*
Gender*
- Male
- Female
Scholarship*
- Yes
- No

Parent/Guardian Information*

Name	Home Phone	Cell Phone	Email

Please list at least one parent/guardian for us to contact if needed.

Emergency Contact Name*
Cell Phone*
Home Phone
Relationship to Camper*
Who will be picking your child up on Friday?*
PLEASE NOTIFY THE CAMP DIRECTOR IF THIS CHANGES.

Please choose the week of camp attending:*
See top of page for dates.
Payment Options*
Church Name to Bill*
Online Processing Fees*
Price: $0.00
Total
$0.00
Credit Card*
American Express
Discover
MasterCard
Visa
Card Number Expiration Date Security Code Cardholder Name