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Summer Camp Program

2013 PA Disciples Youth Camp and Conference

Junior Camp (Entering grades 4-6)
June 23-29

Mini Camp (Entering grades 1-3)
June 30-July 3

Conference II (Entering grades 11-12)
July 7-13

Conference I (Entering grades 9-10)
July 14-20

Chi Rho (Entering grades 7-8)
July 21-27


    • Online Registration

      If your church is sponsoring you for camp, please be sure to include the name of the congregation. If you are not sponsored, please leave the entry blank. NOTE: ONE FORM MUST BE COMPLETED PER CAMP ATTENDEE. IF MULTIPLE CHILDREN FROM YOUR FAMILY ARE ATTENDING, THIS ENTIRE FORM MUST BE COMPLETED FOR EACH CHILD - SEPARATELY.
    • Download Form

      You may also opt to download a registration form, which is at the bottom of this page.
    • Name *


    • Address *







    • Cell Phone Number



    • Camper Birthdate *

    • Please select one: *


    • Name of Parent/Legal Guardian *

    • Grade Entering September 2012 *

    • Sponsoring Congregation Name (if applicable)

    • Parent Email

    • Camper Email

    • Camper Height

    • Camper Weight


    • Camper Info

    • Is the camper frequently subject to:












    • Has the camper had:












    • Please list camper allergies

    • Will the camper need to take medication(s) at camp? (Explain and list):

    • Camper diet restrictions?


    • Additional Information

      Please fill out as completely as possible.
    • Do you consider the camper to be:



    • Any emotional and/or behavioral concerns, or family circumstances which might affect the camper’s full participation?

    • Date of last tetanus immunization:

    • Camper physician name:

    • Physician phone number



    • Insurance name

    • Insured's name

    • Insurance group number

    • Insurance policy number

    • Emergency contact name:

    • Emergency contact phone number




    • Parent/Guardian permission

      In case of an emergency, I hereby give permission to the Camp Director to secure the proper treatment for my child, and I will assume financial responsibility for any services that are rendered necessary. I agree not to hold the Camp Director, staff, the Christian Church in PA, or the sponsoring churches responsible for any accident or illness that might occur to my child while attending camp.
    • Digital signature of parent/guardian: *

    • Date *


    • Camper and Parent/Guardian agreement

      For the health and safety of all campers: (1) Alcohol, illegal drugs, weapons, and other hazardous substances are banned from camp; (2) Campers are not permitted to smoke; (3) Campers who violate these rules will be sent home.
    • Digital signature of camper: *

    • Date *

    • Digital signature of parent/guardian *

    • Date *


    • Payment Information

      Please designate the camp you are registering for by entering the number 1 in the appropriate blank. For example, if you are registering for the Young Adult Retreat, type "1" in the blank below. This form handles only one registration per camper. When finished, click the "Submit" button. You will be redirected to the PayPal site to complete your transaction.
    • Junior Camp (June 23-29 / Entering grades 4-6)
       

    • Mini Camp (June 30-July 3 / Entering grades 1-3)
       

    • Conference II (July 7-13 / Entering grades 11-12)
       

    • Conference I (July 14-20 / Entering grades 9-10)
       

    • Chi Rho (July 21-27 / Entering grades 7-8)
       



NOTE: Do Not Alter These Fields:



Downloads

Title Date
Parent Letter
05/14/2013
View
Camp and Conference Registration Form
04/11/2013
View
Directions to Camp Laurelview
08/01/2012
View
Camp and Conference Rules
08/01/2012
View