TEEN CAMP ONLY AGES 13-18

Registration Options

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Camp T-Shirt

T-Shirt

T-Shirt
$20.00 ea.
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T-Shirt Size

Camper Name

Date of Birth

Camper over 18?

Address

Gender

Male
Female

Church

Camper Signature

I, the undersigned, agree to the terms above.

A signed waiver by event participant or parent/guardian will be required before you can download your QR code. A link to obtain waivers for all registrants will be shown on the confirmation page.

Insurance Company Name

Insurance ID Number

Primary Physician

Physician Phone Number

Yes, it's okay to send me text messages including confirmations, changes, updates, and/or promotions. Message frequency varies. Message and data rates may apply. Reply STOP to cancel. View our terms of service & privacy policy.

Parent/Guardian Name

Parent/Guardian Name (2)

Mobile Phone Number

Address

Emergency Contact

Emergency Contact Number

Parent Signature

I hereby waive any & all claims against the Pentecostal Church of God Southern California District, Inc. or its agents, because of injury or damage that may be incurred to me, my child, and/or property in connection with/or an incident & activity of youth camp. I understand that my insurance is the primary insurance for my child. I also understand that my child may be video recorded. This footage may also be used for future reference not limited to but including video promotions, still shots & the internet.

I, the undersigned, agree to the terms above.

I grant permission to the Pentecostal Church of God Southern California District Inc, to use my image (photographs and video) for use in Media publications including but not limited to:

Videos
Email Blasts
Recruiting Brochures
Newsletters
Magazines
General Publications
Website and/or Affiliates
Other

Please select from the following choices:

I am the parent/legal guardian of the child attending camp.
I am a camper who is 18 years of age or older.

Camper Medical Release Form

Medical Release Form Options

CLICK HERE TO DOWNLOAD THE MEDICAL RELEASE FORM

Disclaimer*

Our camp mixes Jr. High & High School students sometimes topics are discussed that may speak more towards high school students. These topics may include resisting the temptation of pornography and drug addiction. These topics are NOT a primary topic of a message but they may be mentioned as part of a message. You are agreeing to send your child knowing there is a possibility these issues may be discussed.

Running Total

$0.00

Convenience Fee

$0.00

Special Code

Total

$0.00

Event Registration Software by RegFox

TEEN CAMP ONLY AGES 13-18

Registration Options

Camp T-Shirt

T-Shirt

INSURANCE INFORMATION

PARENT GUARDIAN INFORMATION

EMERGENCY CONTACT INFORMATION

Camper Medical Release Form

PAYMENT

**TEEN CAMP ONLY AGES 13-18**

Registration Options

Camp T-Shirt

T-Shirt

INSURANCE INFORMATION

PARENT GUARDIAN INFORMATION

EMERGENCY CONTACT INFORMATION

Camper Medical Release Form

PAYMENT

TEEN CAMP ONLY AGES 13-18