Youth Camp Registration

June 30th - July 4th

Teen must be 12 or turning 12 with 30 days of camp (July 30th)

Child First and Last Name

Birthday

Month

Day

Year

Please Submit Birth Certificate for Age Verification

Permission Slip/ Waiver of Liability

Please complete this form, which will accompany your child to the youth camp. This information is necessary should we need to contact you while your child is in our care. No youth will be allowed to participate without this form being completed and signed by the parent or guardian. The information on this form is considered confidential and will be shared with the youth camp leader/nurse.

Parent/Guardian Name:

Phone

Emergency Contact Name:

Phone

The youth will have access to swimming, ziplining, rock climbing, paintball, and pedal karts. The youth will participate in morning chapel, breakout sessions and groups, and nightly services, all organized by New Destiny Ministry Center (through Bancroft Bible Camp) at 385 Bancroft Chapel Rd. Kingsport, Tennessee, 37660, and/or use of the properties, facilities, and services of the 2026 annual youth camp.

AGREEMENT TO FOLLOW DIRECTIONS, agreement to observe and obey all posted rules, warnings, and further agree to follow any verbal instructions or directions given by leaders, employees, volunteers, or representatives of the 2026 Annual Youth Camp.

ASSUMPTION OF THE RISKS AND RELEASE, I recognize that there is a certain inherent risk associated with the above-described activities and I assume full responsibility for personal injuries to youth and any loss or damage of personal property; 2026 Annual Youth Camp is released and discharged from any liability caused by negligence, reckless, or willful behaviors from youth in attendance.

FEES, I agree to pay all fees associated with attendance.

By typing my name on this form for release of liability and consent for attendance, I represent that I have legal authority over and custody of the child listed above.

Medical/ Medication Release

Please provide the information requested below, as it may be needed in case of an emergency. This information does not modify the information on the emergency card. Upon arrival, all medicines will need to be submitted to the onsite nurse and will be administered as needed.

Allergies:

Conditions requiring special consideration (medical/physical):

Does your youth require EpiPen:

Yes

No

Does your youth require Inhaler:

Yes

No

ANY MEDICATION CURRENTLY TAKEN: (Type of medication and time of administration):

MEDICAL AUTHORIZATION, In the event of any injury to the youth during the above-described activities, I give my permission to 2026 Annual Youth Camp leaders, employees, volunteers, or representatives to arrange for necessary medical treatment for which I will be financially responsible. This temporary authority will begin June 30, 2026, and will remain in effect until terminated in writing by the undersigned or July 4, 2026, whichever occurs first.

TO ANY DOCTOR OR HOSPITAL: I hereby authorize the release of my child’s pertinent medical information to the appropriate professional staff. I give permission to the physician or hospital to secure treatment for him/her and to order medications, injections, anesthesia, or surgery for my child, as named above, in case of emergency.

The signature below constitutes authorization to perform any necessary treatment for my child during their time

with the 2026 Annual Youth Camp.

Parent/Guardian Signature:

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HEALTH INSURANCE INFORMATION:

Upload front and back copy of the insurance card, OR fill out the information below

Insurance Company Name:

Policy #:

Group #:

Subscriber Name

CALL2WAR

Youth Camp Registration

Permission Slip/ Waiver of Liability

Medical/ Medication Release