Bridge Building Applicant Information
Sunday-Friday, July 2 - 7, 2017
Camp Kinard / Heritage at Lowman / Pine Ridge Community Center

Cost : $95 Application Deadline – Two weeks before the start of camp. Contact Pastor Eric after this date.

Staff needs: Up to 30 rising 9th through graduated 12th graders, plus at least 1 male and 1 female 21 years or older.

This camp is a Love Project of the SC LCY organization. The purpose of this event is to build relationships between the generations and to share God’s love in SERVICE to others. If this is not your primary reason for wanting to participate in this camp, do not complete this application. If, on the other hand, you do wish to commit these days to serving the needs of others, prayerfully answer the following questions.

Registration begins at 7pm. We will NOT eat dinner. Please bring snacks and breakfast items for the week to share.

Completing and submitting this registration constitutes your signature, indicating that you agree to the following:

Unless indicated otherwise in the comments, completion of this registration grants photo release rights for social media, annual yearbook, slideshows, and other forms of printed and digital media.

Each youth participant MUST have a valid Emergency Health Form. This must be completed once per school year, so if you've attended an LCY event this year, you've probably completed it. If you need to fill it out or aren't sure you've done it, please follow this link and complete it:

The cost per registrant is $95, but because many congregations supplement this cost, we prefer that payment for the retreat be arranged through the congregation. If you're paying individually, please contact

We can't wait to see you there!

Last Name *
Your answer
First Name *
Your answer
Gender *
Date of Birth *
Grade *
What grade are you in this school year? (If you're filling this out during the summer, what grade did you just complete?)
Name of Parent(s) / Guardian(s) *
Your answer
Home Congregation *
Your answer
Home Address — Street *
Your answer
Home Address — City, State *
Your answer
Home Address — Zip Code *
Your answer
Primary Phone — Adult *
Preferred phone number to reach an adult. (xxx) xxx-xxx
Your answer
Email — Adult *
Preferred email address to reach an adult?
Your answer
Primary Phone — Youth
What's the best number to reach the registrant?
Your answer
Email — Youth
What's the best email address to reach the youth?
Your answer
Congregation Youth Leader *
If you don't have a youth leader, please give your pastor's name.
Your answer
Youth Leader Email *
If you don't have a youth leader, please use your pastor's email.
Your answer
Roommate Preference
Please choose only one.
Your answer
T-Shirt Size *
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