STYC26 - StrongTower Youth Camp

Name

This field is for validation purposes and should be left unchanged.

Parent/Guardian Information

Parent/Guardian Name*

First Last

Email*

Phone*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Home Church / Pastor*

If your church isn't listed, please note your church and Pastors name in the comment box and we will add if for next year.

Church / Pastor add request

Please enter church name and pastor's first and last name.

Camper Information

How Many Campers Am I Registering?*

Please enter a number from 1 to 5.

Must live in the same household.

Name of Camper*

First Last

Age*

Please enter a number greater than or equal to 12.

Gender*

Male

Female

Camper 2 Information

Name of 2nd Camper*

First Last

Age*

Please enter a number greater than or equal to 12.

Gender*

Male

Female

Camper 3 Information

Name of 3rd Camper*

First Last

Age*

Please enter a number greater than or equal to 12.

Gender*

Male

Female

Camper 4 Information

Name of 4th Camper*

First Last

Age*

Please enter a number greater than or equal to 12.

Gender*

Male

Female

Camper 5 Information

Name of 5th Camper*

First Last

Age*

Please enter a number greater than or equal to 12.

Gender*

Male

Female

Medical Information

Medical Insurance Company*

Cardholder's Name*

First Last

Policy Number(s)

Policy Number

Medications Taken By Camper*

Allergies*

Special Needs

This Box Must Be Checked To Submit Form*

I HAVE READ THE RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT. Click HERE to read it.

This Box Must Be Checked To Submit Form*

By checking this box, you agree to the below statement, and also give your child(ren) permission to attend StrongTower Youth Camp.

I, as the legal guardian of the above campers, give permission to the medical or dental personnel selected by the StrongTower administration to order X-rays, routine tests, and treatment for my child in the event of injury or illness, and in the event that I cannot be reached in an emergency, I hereby give permission to the physician or dentist selected by the administration to secure proper treatment for, and to order injection and/or surgery for my child.

I further acknowledge that I will be responsible for the payment of all charges related to the medical or dental services for my child.

By signing below, you agree to the above statement, and also give your child permission to attend StrongTower Youth Camp.

Signature*

Payment Information

Coupon

Registration Cost*

Price:

Transaction Fee

Price: $0.30

This is a flat fee in addition to a percentage for each credit card transaction.

Total

Credit Card

Cardholder Name

Card Details

CAMP STARTS IN:

EXPERIENCE THE PRESENCE OF GOD LIKE NEVER BEFORE!

POWER-PACKED SERVICES

NOT YOUR DADDY’S CAMP ACTIVITIES!

PRAY HARD—PLAY HARD

TRUST US, YOU’VE NEVER EATEN THIS GOOD AT CAMP!

MIND-BLOWING FOOD EXPERIENCE

Parent/Guardian Information

Camper Information

Camper 2 Information

Camper 3 Information

Camper 4 Information

Camper 5 Information

Medical Information

Payment Information

CONTACT

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