Youth Camp Pre-registration Form 2019

Name *
Phone *
Address *
Emergency Contact *
Emergency Contact
Emergency Contact Phone Number *
Emergency Contact Phone Number
Shirt Size *
I hereby give permission to Midwest Youth Camp: *
I acknowledge, understand, and accept that there are inherent risks associated with particaptaion in this program and that doing so could result in an injury. Midwest Youth Camp assumes no liability for injuries or damages from the results of participation. I acknowledge the fact that the Midwest Youth Camp does not provide accident insurance to its program participants. I certify that, to the best of my knowledge, I am physically fit and should this condition change at any time during the program I will notify the Camp Leader/Staff of the Midwest Youth Camp. The camp leader have my permission to call Emergency 911 and/or to send me to a hospital or emergency care facility, and the hospital and medical staff have my authorization to provide emergency treatment deemed necessary for the well being of me. Camp staff has the right to send a camper home who displays a pre-existing medical or behavioral conditions not discussed prior to the start of camp. CONDUCT A SEARCH OF PERSONAL BELONGINGS IF THERE IS REASONABLE SUSPICION THAT THE PARTICIPANT HAS SOMETHING IN HIS/HER POSSESSION THAT IS PROHIBITED (eg: drugs, alcohol, weapons) I agree to abide by all posted, written, or verbally communicated rules and regulations administered by the camp staff concerning this program. I authorize the camp staff to take, display, and publish photographs, slides, or videos for promotional and/or educational purposes.