Registration for Youth Camp

Ages 14 - 17

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Fields marked with an * are required

Parent First Name *

Last Name *

Address *

City

Postal Code

Email *

Phone *

First and Last Name of Child *

Boy

Girl

Date of Birth (M/D/Y) *

Age as of June 30th, this year *

Church Affiliation (If any)

Roommate Request: We do our best to accommodate roommate requests, but no guarantees are made.

I would like to share a cabin with

Please add any allergies/dietary restrictions, comments, or any other important information we should know prior to camp. Thank you for registering!

Comments

How did you hear about camp? *

I DO NOT give permission to have my childs photo/ and or video taken at camp.

I undertake and agree to indemnify and hold blameless the Ministry Staff, Pinecrest Baptist Bible Camp and its Camp Board against any loss, damage or injury suffered by the participant as a result of being part of the activities of Pinecrest Baptist Bible Camp, as well as any medical treatment authorized by the supervising individuals representing the camp. This consent and authorization is effective only when participating in or travelling to events of Pinecrest Baptist Bible Camp. *