YFC Waitlist Registration 2024 - Youth Fellowship Camp

First Name *

Last Name *

Preferred Name

*Nickname you prefer to go by: this will be the name used on all camp lists.

Gender *

Male
Female

Birthdate *

Age *

Ages are 12-15. 1st year campers must turn 12 by the last day of camp, which is 7/5/24.

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Parents or Guardian *

Mother's Number

Home Phone/Work Phone/Cell Phone

Father's Number

Home Phone/Work Phone/Cell Phone

Email *

This MUST be a PARENT’S or GUARDIAN’S email address, not the camper’s email address. Communication to parents/guardians will be sent via email.

Church Name and address *

If not attending a church at this time, just type that in. No problem! Or add the information of a person close to you that you consider a Godly mentor in your life!

Pastor's Name *

Pastor's Phone Number

Date of last tetanus shot

Family Doctor *

Name and Telephone Number

Camper can take Ibuprofen

Yes
No

Camper can take Tylenol

Yes
No

Camper can take Pepto

Yes
No

Camper can take Tums

Yes
No

Any allergies? *

Yes
No

What is the allergy and reaction to it? *

Medical Problems

Please List any medical issues the camper has currently or has had within the last year

Any Medications? *

Yes
No

Prescriptions or over the counter medication your child will be needing at camp

List names, dosage, and times to administer medication. *

I do hereby give my consent for any necessary medical treatment to be rendered to the above named minor while they are at Youth Fellowship Camp located Prairie Camp (63526 CR 9 Goshen IN 46526). Medical treatment that may include emergency examination, aesthetic, medical diagnosis, minor surgery or treatment, and/or care. This will be rendered under the general or special supervision and on the advice of any physician licensed to practice medicine. I understand this is to be used only if I cannot be reached. I understand this is to allow emergency treatment to be initiated without delay and the staff will continue efforts to contact me. Secondary medical insurance is covered in the cost of registration. I further recognize that certain hazards and dangers are a possibility at camp events. I understand also, that although the camp has taken precautions to provide proper supervision, and instruction for each activity, it is impossible for the camp to guarantee absolute safety. Further, I waive any claim that may arise against Youth Fellowship Camp, Griner Church, Prairie Camp. The Missionary Church, North Central District, Inc. and/or employees or volunteers, as a result of participation in the program, except for those that are a direct result of gross negligence of the camp or its employees and/or volunteers. I also give permission as a parent or guardian for my child to be photographed or videotaped for promotional purposes of Youth Fellowship Camp. I am also aware of the Youth Fellowship Camp guidelines and am willing to follow the standard of the dress code. Sending my child to camp includes the risk of possible exposure to and illness from COVID-19. I knowingly and freely assume all such risks related to possible exposure to COVID-19. I release Prairie campground and Youth Fellowship Camp (YFC), and all individuals connected to YFC of any responsibility should my child contract COVID-19, as a result of participating in camp.

Parent Signature *

First

Last

Type Parent/ Guardian name here to show you have read and agree with the above statement.

Camper Signature *

First

Last

Type Camper Name here to show you have read and agree with the above statement.

Snack Shop Update

Important Snack Shop Change: This year, each camper will have a $20 snack shop credit automatically included for the week of camp.This credit will have no cash value at the end of camp. Your camper is welcome to bring additional cash to add to their snack shop fund. If any portion of the cash which they have brought has not been used, it will be refunded to the nearest dollar on Friday night, after supper. Additional cash for the snack shop fund should be turned in on Sunday, at registration.

T-Shirt *

Everyone will get a tee shirt. It is included in the registration fee!

Has the applicant been to YFC before? *

Yes
No

How did you hear about Youth Fellowship Camp?

Activity Choices

Select your first 4 choices for activity classes. We try our best to put you into your first choices, but some classes can fill up quickly.

1st Activity Choice *

Select your first choice for activity period.

2nd Activity Choice *

Select your second choice for activity periods.

3rd Activity Choice *

Select a third choice in case your first 2 choices are full.

4th Activity Choice *

Select a fourth choice in case your first two options aren’t available.

Additional Questions or Comments