2018 Private Schools Fall Weekend
November 16-18, 2018 at Carolina Point.. Join your friends and leaders from Covenant Day, Charlotte Christian, Charlotte Latin, and Charlotte Country Day for our favorite weekend of the year!

Total Cost = $195

Pay online or mail a check to "Young Life" 4420 Rea Rd. Charlotte, NC 28226

https://payments.younglife.org/triplink.cfm?TripId=BWY8WB8S6S67
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Camper's First Name *
Last Name *
School *
Grade *
Gender *
Shirt Size - standard adult size *
Parent Name(s) *
Phone *
Email *
Street Address *
City *
State *
Zip *
Emergency Contact Name *
Relationship to Camper *
Emergency Contact Phone *
Insurance Company *
Insurance Policy # *
In the event the your child becomes ill or injured while attending Young Life 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 the permission to act in my behalf in seeking emergency treatment for my child in the event that such treatment is deemed necessary by Young Life. I hereby give permission to the medical personnel selected by Young Life to order x-rays, routine tests, treatment; maintain and/or releases any medical records necessary for insurance purposes as outlined under the HIPAA regulations. *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 Private Practice, log onto www.younglife.org or call 719-381-1950.. I hereby grant Young Life the right to use, reproduce, distribute photographs, films, video tapes and sound recording of my child without compensation or approval rights *Parents MUST read this *
*This is the only consent release form you need*
I understand that I am not fully registered for camp until I complete one of the following: *
I understand that no refunds can be given after November 9th except in the case of a family emergency *
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