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YOUNG LIFE WINDY GAP TRIP JULY 18-22 2020
This is our registration form for our high school Summer Trip 2020 to YL's Windy Gap! Please register your child/camper by filling out this form and then submitting payment either online or through their YL leader, or, you may simply mail in your payment. Checks payable to Young Life Loudon County PO Box 735 Lenoir City, TN 37771

Questions? call us: 865-271-0098 or email: info@lc.younglife.org OR call Holly: 865-748-7127.

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After this... parents, you will get more info about Health Form, payment info, etc. We know this is a unique year due to COVID-19, please refer to our parent email with details on how we are keeping kids safe. If you did not receive one, please let us know.
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CAMPER NAME: (first) *
CAMPER NAME: (last) *
ADDRESS: *
CITY: *
ZIP: *
CAMPER email: *
CAMPER cell phone number: *
GRADE: *
SCHOOL: *
PARENT NAME: *
PARENT email address: *
PARENT cell phone number: *
Gender: *
Payment method: *
DISCLAIMER / WAIVER INFO -Important:  A non-refundable $50 deposit is required to hold your spot.  The remaining balance is due prior to departure.  I give my son/daughter permission to attend YL's Windy Gap week long summer camp with Young Life Loudon County. In the event that your child becomes ill or injured while attending Young Life’s Windy Gap summer camp, we request that Young Life be given permission to take your child to the nearest medical facility or healthcare provider and have the necessary treatment administered. Your signature verifies your child is in good health and capable of participating in strenuous activities. Your signature will also acknowledge your acceptance and understanding of Young life’s role in the medical treatment of your child. In case of emergency, I understand that every effort will be made to contact me. If I cannot be reached, I hereby give Young Life to act in my behalf in seeking emergency treatment for my child in the event that such treatment is necessary for insurance purposes as outlined under the HIPAA regulations. I recognize that any medical treatment that is provided to me (or my child) while attending a Young Life activity will be paid for by my medical insurance company and guarantee payment for services not paid by insurance. Young Life provides SECONDARY insurance for accidents in the amount of $20,000 medical, $4,000 dental. Claims less than $250 are covered in full by Young Life. *I absolve Young Life from liability in acting on my behalf in this regard. * Young Life is compliant with Health Insurance Portability and Accountability Act (or HIPAA) To obtain a copy of Young Life’s Notice of Privacy Practice, log onto www.younglife.org or call 719-381-1950…I hereby grant Young Life the right to use films, video tapes and sound recording of my child without compensation or approval rights. I acknowledge that I will, in addition,  be required to complete an online Health Form with Young Life for my son / daughter's registration to be complete. (Link on our website) *
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