CCYL Campaigner Overnight 2019
Please fill out this form completely to register for the Chesapeake Bay YL Regional Campaigner Overnight from January 25th-26th! A $35 payment is required in order to complete your registration. You may pay for the trip using a credit card, debit card, or online transfer at https://payments.younglife.org/triplink.cfm?TripId=XF4V4VAD6V3X or by clicking the "Pay for Camp" button on the Campaigner Overnight page.

*We would prefer for you to make your payment online. But you may turn in cash or a check to your Young Life leader at club or mail a check to the Carroll County Young Life office (55 Ridge Rd / Westminster, MD 21157).

First Name *
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Last Name *
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Gender *
Date of Birth *
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School/Campaigners group you attend *
Grade in 2018-2019 School Year *
Camper Cell Phone *
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Camper Email *
Your answer
Parent/Guardian First and Last Name *
Your answer
Parent/Guardian Email Address *
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Parent/Guardian Cell Phone # or Home Phone # *
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Medical Insurance Policy Provider *
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Medical Insurance Policy Number *
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Allergies
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Special Dietary Needs
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Waiver, Release, & Idemnification Agreement
Parents, please read the Waiver, Release, & Idemnification Agreement below and electronically sign and date to confirm you have read it...
Parent/Guardian Name *
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Date signed *
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