YBC Bible Camp

Mentoring young lives for Christ...

12th Annual 2019 Youngstown Baptist Church Bible Camp

JUNE 17th-21st is ACCEPTING REGISTRATION FORMS!!!

Our bible camp is one of our biggest ministries at Youngstown and it all started 12 years ago in The Stalcup Family's cow pasture just off Tate Rd in Blairsville. We now use the Mountain Fellowship Camp in Suches, GA www.mtnfellowshipcamp.org. The facilities are incredible! Check out some of the pictures below and on the website. God has amazingly blessed our camp and we're proud to host our 12th year. We encourage all parents to visit the camp & tour the cabins & beautiful facilities. It’s truly majestic!!

ONLY FOR GRADES 3-12!

2019 BIBLE CAMP REGISTRATION FORM

After completing this form, review the printable version forms below to understand the ZERO TOLERANCE RULES and to know WHAT TO BRING! IF YOU CANNOT COME TO OUR CAMP AFTER COMPLETING THE FORM...PLEASE LET US KNOW BY EMAILING YOUNGSTOWNBAPTISTCHURCH@YAHOO.COM. THANKS SOOOO MUCH!

* Indicates required field

Camper's Name *

First

Last

Parent's Email *

Primary Cell or Contact Phone Number *

Secondary Phone Number *

Did you Attend in Years Past? *

Mom's Name *

First

Last

Father's Name *

First

Last

Guardian's Name - If Not a Parent *

First

Last

Child's Home Address *

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Line 2

City

State

Zip Code

Country

Date of Birth *

Male or Female *

Male Female

Grade 2019-2020 (3rd -12th) *

With Whom Does the Child Live With? *

Name of Church *

Please list any custody issues or helpful information about your child/family: *

Photo Permission: I grant permission to Youngstown Baptist Church to video, photograph, and/or record my child participating in our youth activities. *

YES! NO! PLEASE REFRAIN

Names of all persons who are authorized to pick up your child, including parents and guardians should be listed here. Proper picture identification may be required before a child is released. Check in upon arrival and check out is required.

Name *

First

Last

Phone Number *

Name *

First

Last

Phone Number *

Name *

First

Last

Phone Number *

Registration & Liability Release Form

I, the parent or guardian, (HEREAFTER"I") have voluntarily elected to allow my child(ren), name(s) stated above (hereafter “child(ren)”) to participate in activities conducted at Youngstown Baptist Church Bible Camp at Mountain Fellowship Camp in Suches, Georgia (hereafter “Event”) from June 17 to June 21. WARNING: BOUNCING ON A BOUNCE HOUSE MAY PRODUCE INJURY AND/OR DEATH.

I specifically have voluntarily elected to allow my child(ren) to play on the bounce house(s) during the Event. I fully understand that this involves jumping on air filled entertainment toy(s) and that there are health and safety risks associated with this type of activity. I, therefore, assume all risk of injury and/or death associated with my child(ren)’s participation in playing on the bounce house and any other activities conducted during the Event and I will not hold the Event organizers, sponsors, or anyone affiliated with them (including, but not limited, to Don Anderson - Mountain Fellowship Camp in Suches, GA, Youngstown Baptist Church, and/or their agents, representatives, or employees) liable for any circumstances of this event.

I hereby confirm that my child(ren) are in good physical condition and do not suffer from any disabilities or physical conditions that places him/her or others at risk or otherwise should prohibit their participation in the Event.
I HEREBY WAIVE AND RELEASE, INDEMNIFY AND HOLD HARMLESS AND FOREVER DISCHARGE, Don Anderson – Mountain Fellowship Camp in Suches, GA, Youngstown Baptist Church, and/or their agents, representatives, employees, volunteers, officers, directors, affiliates, and their respective heirs, representatives, and all persons, firms, corporations, whether or not herein named (hereafter “Released Parties”), from any and all claims, demands, debts, contracts, expenses, causes of action, lawsuits, damages and liabilities, of every kind and nature, whether known or unknown, in law or equity, which I or my child(ren) may have or hereafter have, arising from or in any way relating to my child(ren)’s participation in any of the events or activities conducted by the Released Parties, on the premises of the Released Parties, or for the benefit of the Released Parties.

I understand that the activities that my child(ren) may participate in are inherently dangerous and his/her/their participation may cause harm or grievous injuries, including bodily injury, damage to personal property and/or death. I, on behalf of my child(ren), my spouse, heirs, executors, administrators, representatives, successors and assigns, and next of kin, hereby waive all claims for damages, injuries, and/or death sustained to my child(ren) or property that I may have against the aforementioned Released Parties to such Event.

By this WAIVER AND RELEASE, I assume any risk, and take full responsibility of any and all claims of personal injury and death or damages to, including, but not limited to, my child(ren)’s use of the Released Parties’ facilities and/or engaging in the Released Parties’ activities or other activities during the Event or on or near the Released Parties’ premises.

This WAIVER AND RELEASE contains the full and complete agreement between the Parties, the terms are contractual and not merely a recital and supersedes any and all prior written or oral agreements and representations between the Parties concerning the activities during the Event. Any additions or changes to this WAIVER AND RELEASE shall be valid only if set forth in writing and signed by all the Parties.

Furthermore, this WAIVER AND RELEASE is binding upon the undersigned, and his/her spouse, heirs, next of kin, executors, administrators, representatives, successors and/or assigns.

This WAIVER AND RELEASE shall be subject to the laws of the State of Georgia. If any portion of this WAIVER AND RELEASE is held to be invalid, the balance hereof, notwithstanding such holding, shall remain in full force and effect.

I acknowledge that I have read, understand, and fully agree to the terms of this WAIVER AND RELEASE and its contents. I understand and confirm that by signing his WAIVER AND RELEASE I have given up considerable future legal rights. I have signed this WAIVER AND RELEASE voluntarily, under no duress or threat of duress, without inducement, promise, or guarantee being communicated to me.

I hereby affirm that I am 18 years of age or older and mentally competent to enter into this WAIVER AND RELEASE. I hereby affirm that I am signing as a parent or legal guardian of said child(ren). I represent that I have the full authority to do so, realizing that this release is binding upon the minor child(ren) as well as myself.

YES, I accept the terms and allow my child to participate in activities conducted during the Event, including, but not limited to, the bounce house activity. *

Yes

NO, My child may not participate in the bounce house activity. *

NO, My child(ren) may not participate in the following activities conducted during the event. *

My Child(ren) may not participate in activities conducted during event. *

Typing my name below means that I am in full agreement with disclosure above *

First

Last

CAMPER COVENANT I have read the Camp Rules & Regulations as outlined in the camp Information letter. I promise to abide by the rules and regulations and all instructions given by any adult member of my camp. Furthermore, I understand that I will be sent home from camp for breaking any rule or any disruptive or unbecoming behavior that is not immediately corrected as requested.

Did you read the Camper Rules & discuss the Campers Covenant with Your Child or Children? *

YES NOT YET!

Medical Release Form

I, the parent of the child listed above hereby give permission for any and all medical attention to be administrated to my child in the event of accident, injury, sickness, etc. under the direction of the person(s) listed below, until such a time as I may be contacted. I also assume the responsibility for the payment of any such treatment, releasing DON ANDERSON, and/or Youngstown Baptist Church and/or its employees or agents of any responsibility or liability. This release is effective for the period of one year from the date given below.

Medical Conditions & Physical Restrictions to Be Aware of: *

Physician's Name *

Physician's Phone Number *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Insurance Company Name *

Policy Number *

Insurance Company Address *

In case I cannot be reached, any representative of Youngstown Baptist Church Youth Camp can act on my behalf, including, but not limited to CPR, First Aid, transportation, and transfer of medical records to emergency facility if needed.

Known Allergies *

Medications & Times to Take Each *

Typing my name below means I am in full agreement with the medical release above *

First

Last

Submit

Extras!

It's all about the Extras that make our camp special...at the camp on Monday at registration, we ask you to complete a couple of options for your child to do every day or every other day (depending on the option)!!! Extras like...Hiking, Fishing, Sportsman or Sportswoman Option, Tie Dye Shirts, Slime Making, Drawing, Sign Language Songs & more! LOOKING FORWARD TO ANOTHER GREAT YEAR AT BIBLE CAMP...CAN'T WAIT FOR 2019 CAMP!

​​Mentoring young lives for Christ...

12th Annual 2019 Youngstown Baptist Church Bible CampJUNE 17th-21st is ACCEPTING REGISTRATION FORMS!!!

2019 BIBLE CAMP REGISTRATION FORM

Extras!

Mentoring young lives for Christ...

12th Annual 2019 Youngstown Baptist Church Bible Camp

JUNE 17th-21st is ACCEPTING REGISTRATION FORMS!!!