West Virginia Youth Camp 2008

Junior Camp - Ages 6-9 - June 30-July 3, 2008

Intermediate Camp Ages 10-13 - July 7-11, 2008

Teen Camp Ages 14-18 - Jul 14-18, 2008

First Name:

 

Last Name:

 

Address Line 1:

 

Address Line 2:

 

City:

 

State:

 

Zip Code:

 

Primary Phone Number:

 

Secondary Phone Number:

 

Emergency Phone Number:

 

Email Address:

 

Birthdate:

 

Age:

 

Sex:

 

Which camp will you be attending?

 

Who would you like to room with?

 

MEDICAL INFORMATION (Required)

 
Parent's Insurance Company:

 

Policy Number:

 

Is pre-authorization required?

 

Please list any allergies or medical problems to be noted:

 

Please Read Carefully! All applications must be initialed by a parent or legal guardian.

I hereby give my child permission to attend and participate in the West Virginia Church of God Youth Camp. I hereby waive release and discharge any and all claims, demands and causes of actions against camp officials, the Church of God in West Virginia and the International Offices of the Church of God, their agents, employees and participants arising from any damages, property loss or injury my child may sustain at West Virginia Church of God Youth Camp. I further consent to allow camp officials to seek and obtain emergency medical or surgical treatment for my child if efforts to contact me for my consent have been unsuccessful and/or if my child requires immediate medical treatment.

 
Initials of parent or legal guardian:

 

Which local church do you attend?

 

Pastor's Name:

 

I give permission for my child to be baptized in water if they express a desire to do so.