Camp Elements - Registration Form

This registration form must be completed by a parent / guardian of the youth that is participating in Camp Elements. Some of the questions are for your youth to complete. Please review questions and answers together before registering.

Parent's Info

Parent's Full Name

Parent's Cellphone Number

Parent's Email

This address will receive a confirmation email

Youth's Info

Youth's Full Name

Youth's Cellphone Number

Youth's Email

Home Address

Gender

Please select one option.

Male Female

Birthdate

Grade for 2020-2021 school year

Please select one option.

5th 6th 7th 8th 9th 10th 11th 12th

Name of school

Answers from the Youth participant

What are you hoping to get out of this camp?

Other important info

Emergency Contact Name

Emergency Contact Phone Number

List any allergies

List any prescribed medications

List any physical limitations

List any dietary restrictions

Acknowledgements required

We acknowledge that the full camp fee of $340 per youth is due by June 30th, 2021

Please select all that apply.

Yes

We acknowledge that any funds donated for the camp, are to be used only for the camp, or returned to the respective donors, if the youth does not go on the camp.

Please select all that apply.

Yes

We acknowledge that there will be a code of conduct that the youth will be asked to sign, and the parent to acknowledge prior to the camp.

Please select all that apply.

Yes

We acknowledge that there will be waivers to be signed and notarized prior to the camp. We have a notary available at youth group in June.

Please select all that apply.

Yes

We acknowledge that if a participant is 18 years or older at the time of the camp, there will be a form requiring their SSN and authorization to perfom the background check.

Please select all that apply.

Yes

There is a $40 non-refundable registration fee, which counts towards to $340 camp fee. $40

Credit/Debit Card Number

Expiration Date/CVC

Name on Card

Card Billing Address

Camp Elements - Registration Form

Description

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