2019 Michigan Youth Leadership Training Camper Registration
Fun & Adventure?
Wilderness & Discovery?
Food & New Friends?

ONLY $25 for 4 days of camp!!! (Deposit is non-refundable! )
A spot at camp is not locked in until all paperwork is completed and we receive a $25 payment.)

Bringing youth together from across the region for the opportunity
to network, learn, and make friends.

Dates of Camp:

Drop-Off Location:
Ionia County Intermediate School District
2191 Harwood Rd,
Ionia MI 48846
June 23rd, 10:00 am

Camp/Pick Up Location:
Camp Tuhsmeheta,
10500 Lincoln Lake Rd. NE,
Greenville MI 48838
June 26th, 5 pm

Registration Deadline: May 31st, 2019
Cost: $25 (scholarships available)

In order to complete the registration, you need to fill out the Camper Registration, fax/mail in a copy of insurance, and send in the registration fee. If paying by check, please make the check out to the Ionia County Intermediate School District and please write within the memo "MIYLT" and mail attn:

Deborah Wagner
Ionia County Intermediate School District
2191 Harwood Rd.
Ionia, MI 48846

Registration includes having a copy of the camper's insurance card faxed to the
Ionia County ISD, 616-527-4731 attn: Deb Wagner

NOTE: MIYLT is a one time camp as a camper. We encourage past campers to apply as staff (for more information go back to the miylt.org website, under forms, go to the staff application form, and see the staff descriptions at the bottom of the form.)

Camper Name *
Your answer
Camper Address *
Please include street, city, & zip code.
Your answer
Mailing Address
(if different than camper address) Please include street, city, & zip code.
Your answer
Parent/Guardian Email *
Your answer
School *
Your answer
Camper Date of Birth *
MM
/
DD
/
YYYY
Camper Grade *
Please select the grade the camper will attend in the Fall of 2018.
Camper Gender *
T-Shirt Size *
Home/Cell Phone *
Your answer
Emergency Contact #1 Name: *
Your answer
Emergency Contact #1 Relation to Camper: *
Your answer
Emergency Contact #1 Phone Number: *
Your answer
Emergency Contact #2 Name: *
Your answer
Emergency Contact #2 Relation to Camper: *
Your answer
Emergency Contact #2 Phone Number: *
Your answer
Authorization *
In registering and permitting my child to attend the Michigan Youth Leadership Training Camp, I, the parent, guardian, or other duly authorized party, hereby agree to permit my child to participate in a full range of activities and authorize the Michigan Youth Leadership Training Camp staff, in the event of an accident, injury, or illness affecting my child, to authorize on my behalf all medical and other procedures, including admission to hospital and all other necessary treatment, as he/she may deem essential for care and well-being of my child. Such action is to be taken only when immediate contact with the parent, guardian, or other duly authorized party cannot be made. Insert any qualifications of the camp's authority as set out above here:
Your answer
Transportation *
How will your child get from home to the Ionia County Intermediate School District on June 23, 2019? How will your child get from Camp Tuhsmeheta to home on June 26th? **Disclaimer: Understanding that these are two different locations.
Your answer
Transportation (continued) *
In the event that the person named above cannot pick up your child, she (he) may be released only to the following people. (Please list at least 2 people along with a phone number to reach them at. By naming these specific people you are authorizing that they can pick up your child if the person named above cannot.
Your answer
Photo/Video Release *
I authorize the Michigan Youth Leadership Training Camp to use any photos or videos of my child obtained while engaged in Michigan Youth Leadership Training Camp activities for promotional purposes.
Payment *
I will pay the $25 registration fee by: (Please note, this is a non-refundable fee if the camper does not attend the camp)
Commitment *
We certify that the information contained in this registration form is complete and accurate. By submitting this registration form and providing payment, the camper and parent, guardian, or other duly authorized party, will be at camp June 23th to June 26th. If the camper can not attend after submitting this form and payment, we understand it is non-refundable and we will contact the camp director or staff to inform them.
How did you hear about camp? *
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