YAC

Ages: 18-30
September 1-4
$100 per camper
Please note you must fill a separate from from for each camper.

Camper Information
Name *
Name
Mailing Address *
Mailing Address
Home Phone
Home Phone
Cell Phone
Cell Phone
Medical And Emergency Contact Infromation
Emergency Contact *
Emergency Contact
Contact Home Number
Contact Home Number
Contact Cell Number
Contact Cell Number
ALL MEDICATION (PRESCRIPTION AND NON-PRESCRIPTION) IS TO BE LEFT WITH DESIGNATED CAMP HEALTH/FIRST AID PERSONNEL AT ON-SITE REGISTRATION.
Permission for Contact
Please sign below if you wish to give camp staff permission to stay in contact with yourself We count it a privilege that you have come to our camp! During camp some incredible friendships are formed, and our amazing staff love staying connected with their campers — keeping updated on their school year, sports involvement, and answering any questions they may have about things we talked about during chapels and devotions. We are committed to honouring your privacy and seek your permission for our staff to stay invested in you life. If you approve of our staff staying in contact with yourself please check the signature box below. Should you have any questions, comments, or concerns please do not hesitate to contact us here at ELBC. If you ever desire to withdraw your permission, please contact ELBC to notify us and we will ensure compliance.
Date *
Date
Parent/Guardian/Participant Release
*
Date *
Date

*After submitting the form an option to pay online with PayPal will be available.