YOUTH CAMP REGISTRATION

JUly 23-27, 2025

Jericho Hills Camp & Retreat Center Lucas, IA

Registration begins: 1:00pm

Name

First Name

Last Name

Age

Shirt Size

Phone Number

Address

Emergency Contact Name and Number

Church

Health Insurance Company and Policy Number

Please list any allergies or dietary restrictions

Dress Code * All campers, staff and guests are expected to respect God, each other and oneself at all times. Modesty includes appropriate behavior, language and conversation, and appropriate dress. TOPS All shirts must have sleeves. No tank tops. T-SHIRTS RECOMENDED BOTTOMS Shorts/Skirts must be knee- length. CHURCH SERVICES Pants (for guys) and dresses/skirts (for girls) SWIMMING Shirts must be worn at all times unless swimming. (for guys) One-piece swimsuit or shirt must be worn when swimming (for girls) SHORTS ARE REQUIRED (BOYS AND GIRLS) -Be comfortable, but conservative. -Campers may not wear apparel that is extremely tight fitting. Examples of clothes that are considered tight-fitting are: yoga pants, jeggings, or spanx. Leggings may be worn with dresses and long t-shirts.  -If in doubt about any particular article of clothing, we ask that it be left at home. The intent is to not bring attention to how one looks, but to highlight our walk of faith, love and pursuit of holiness. Therefore, campers and staff are required to adhere to the Camp Dress Code.  Anyone in violation of this policy will be asked to change clothes or make the appropriate changes to render their clothing modest.

I have read and understand dress code rules & regulations.

Midwest Youth Camp Rules * We believe that in order to achieve the goals of youth camp, full cooperation of all participants is required. All campers must abide by the following rules: 1) All campers must participate in the scheduled daily activities.   2) Campers are not permitted to leave the territory of the camp without first obtaining permission from the   camp’s main representatives. 3) No visiting of opposite gender campers in sleeping units   4) There will be zero tolerance toward illegal/non-prescribed drugs, alcohol, tobacco use or possession of  weapons. Such will lead to expulsion from campground with no refund.   5) Campers clothe yourselves modestly, not provocatively or in any revealing way, otherwise you will be asked to change.   6) All camp quiet hours are from 11pm – 7am. Everyone should be in their assigned building.   7) Follow the rules of fire safely: Campfires are allowed in designated locations only. FIREWORKS ARE NOT ALLOWED ON CAMPGROUNDS. Follow the rules of lake safety: always wear a lifejacket when in a boat.   8) Arguments, foul language, un-Christian like behavior, violation of rules are sufficient basis for expulsion from campgrounds.    I hereby give permission to Midwest Youth Camp: * To provide transportation to off-site areas or for medical attention as deemed appropriate by the camp director.   * To designate a Camp Physician, in case of an emergency if emergency contact cannot be reached, to secure  proper treatment for, and/or order injections, hospitalization, anesthetics or surgery.   * I authorize the camp staff to take, display, and publish photographs, slides or videos for promotional and/or  educational purposes.   * I acknowledge, understand, and accept that there are inherent risks associated with participation in this  program and that doing so could result in 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 Leaders of the Midwest Youth Camp.   * Camp staff have the right to send a camper home who displays a pre-existing medical or behavioral condition not discussed prior to the start of camp and to CODUCT A SEARCH OF PERSONAL BELONINGS IF THERE IS REASONABLE SUSPICION THAT THE PARTICIPANT HAS SOMETHING IN HIS/HER POSSESSION THAT IS PROHIBITED (ex: drugs, alcohol, weapons).   * I agree to abide by all posted, written, or verbally communicated rules and regulations administrated by the camp staff concerning this program.

I have read the policies and agree to all the conditions of this registration.

PAYMENTS ACCEPTED UPON ARRIVAL