YES CAMPER REGISTRATION
Email address *
Camper Information
First Name *
Your answer
Last Name *
Your answer
Gender *
Age (At the time of Camp) *
Your answer
Grade (Next School Year) *
Camp Attending *
T-Shirt Size (Pre-Teen Camp Only)
Swimming Level *
Dorm Mate Request #1 (Pre-Teen Only)
Your answer
Dorm Mate Request #2 (Pre-Teen Only)
Your answer
Bus Transportation
The cost for traveling by bus is $10 for pickup and return to Baton Rouge or Lafayette. Payment is made at the end of this registration process.
Taking Bus to Camp? *
Parent/Guardian Information
Parent/Guardian #1 *
Your answer
Parent/Guardian #1 Phone Number *
Your answer
Parent/Guardian #1 Email
Your answer
Parent/Guardian #2
Your answer
Parent/Guardian #2 Phone Number
Your answer
Emergency Contacts
If I can not be reached in an emergency, the following people will know my whereabouts and/or have my permission to represent my wishes regarding medical or any other emergency care for my child.
Emergency Contact #1 Name *
Your answer
Emergency Contact #1 Phone Number *
Your answer
Emergency Contact #2 Name
Your answer
Emergency Contact #1 Phone Number
Your answer
Staff Application (Optional)
If you are a teenager and interested in applying for a staff position at Pre-Teen Camp, please fill out the following section. Otherwise please skip this section and proceed to the next section: Permissions and Conditions.
I have attended YES Camp before as:
Why Do you want to be on staff at YES Camp?
Your answer
What experience, special gifts and/or talents do you have that will contribute to camp?
Your answer
T-Shirt Size
Have you been assigned a Staff position?
If you answered "No" to the previous question, please check 3 Staff positions you would be most interested in:
Permissions and Conditions
General Permissions: I agree and understand that this event is sponsored by Generations Ministries of Grace Communion International, and depending upon circumstances, and without limitation, may involve both a physical / athletic activities such as sports, hiking, camping, arts and crafts and the spiritual or religious activities, such as Christian Living or education classes, religious worship services, and the like. I give my permission for my child to engage in all such activities.

Acceptance Of Event Conditions: I understand and agree to the conditions of the event venue as described in the information provided. I give permission for my child to participate under these conditions.

Disclosure Of Special Health Conditions: The following is a list of my child’s special health conditions and needs of which event staff need to be aware. (List below such things as medications, history of seizures, motion sickness, allergies, Etc)

Release of liability regarding special health conditions: I submit that the above-mentioned special health conditions and instructions are needed for my child while at the event. I understand that, although event Personnel will seek to help accommodate these special conditions, such as by giving medications and or by seeking to take appropriate precautions, Etc., nonetheless by sending my child to the event with the special health conditions:

I acknowledge that I understand the event is not equipped to monitor or supervise such special conditions or needs as would the parent if he / she were present.

I certify it is safe for my child to participate and all event activities notwithstanding the special conditions, and notwithstanding any possible laps in medication, or possible interaction with other people or circumstances that may affect the special conditions.

I release and indemnify the event from all claims and liability stemming from the special conditions, including, without limitation, any claim, illness, or injury. Resulting from the events failure to properly administer medicines for the special conditions. Failure to recognize a situation which might be potentially harmful to a person with the special condition, or failure to recognize the onset of an episode of the special conditions.

Permission to secure Emergency Services: I give permission to the event staff to secure usual and customary medical and or legal services for my child if needed in an emergency circumstance at the event. I as Parent / Guardian will be responsible for the cost of such Services if not covered by my insurance.

Medications and Insurance
Do we have permission to administer basic first aid and/over-the-counter medications? (Tylenol, Ibuprofen, Antihistamines, etc.) *
If Yes, are there any medications you do not want your child to have?
Your answer
Please list any special health conditions such as medications, history of seizures, allergies, etc.
Your answer
Insurance Coverage: "My child is covered by medical insurance: *
If yes, list the name of the Insurance Company:
Your answer
If yes, list the Policy Number:
Your answer
I am in agreement with all information and conditions posted under Camper Information, Parent/Guardian Information, Staff Information, if applicable and Permissions and Conditions. Please type your name if you are in agreement with the information and conditions stated in this form. *
Your answer
Cell Phone Release Policy
I understand that cell phones can be a distraction at camp and have discussed with hmy child that the phone is to be used only to call me, and that he/she will request permission from a senior staff member prior to calling me. Any other use of cellphones is not permitted. The purpose of this policy is to minimize the distractions of our teens and pre-teens while they are at camp. Because cell phones can become a distraction from the purpose of our camp, we are asking that all campers (teens and pre-teens) leave their cell phones at home. If parents need to reach their son or daughter at camp, they may call the cell phone numbers below which senior staff persons will have their phones with them at all times and can easily reach your child. We appreciate your understanding.

Christi Johnson: 662-444-8505
Brandon Antwine: 225-354-5766

Note. If a parent would feel more comfortable having their child bring a cell phone to camp for safety reasons, please say “yes” in the box below:

My child is authorized to bring a cell phone to camp: *
Please type your name if you answered yes to authorize your child to bring a cell phone to camp and agree with the camp rules concerning use of cell phones.
Your answer
Photo Release
I understand that YES Summer Camp may use any photos or videos taken of my child at camp for use in their Publications or those of Grace Communion International: *
If you answered "yes" please type your name:
Your answer
Camp Fee and Scholarship Request
The total cost to attend camp for each camper is $100. However, we understand that it could be a hardship for families with multiple children attending camp to afford the full tuition fee. Therefore, we are able to give $75 scholarships to help families with multiple children and lower income families. A lower income family is defined as a combined family income of under $50,000 per year. We have limited scholarship funds available and we ask parents/guardians to prayerfully consider the options below.
Please select one of the following options: *
Payment Amount
*
IMPORTANT - Click "SUBMIT", Then Click the link to make a PAYMENT
Your application is not complete until you SUBMIT and make a PAYMENT
A copy of your responses will be emailed to the address you provided.
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