logo God's Missionary
Youth Camp

GOD'S MISSIONARY YOUTH CAMP: WHERE GOD IS FIRST AND EVERYTHING ELSE IS SECOND

Registration

For Ages: 12-20
Located on the Campus of Penn View Bible Institute
Registration Info: Treasurer Terry Yoder (570) 765-1696 or terryleeyoder@yahoo.com

Camper Information


Camper Shirt
Bringing your own mattress: You will recieve a $5 refund at GMYC if you bring your own.

Parent/Guardian Information

Emergency Information

name and cell phone from Parent/Guardian.

Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared by God's Missionary Youth Camp during the selected camp. In exchange for the acceptance of said child’s candidacy by God's Missionary Youth Camp. I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless God's Missionary Youth Camp and all its respective leaders, staff and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected camp sessions.

In case of injury to said child, I hereby waive all claims against God's Missionary Youth Camp. including all coaches and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in all sports activities. Some of these injuries include, but are not limited to, the risk of fractures, paralysis, or death.

Media Release and Acknowledgement

God's Missionary Youth Camp has my permission to use photographs and videos publically to promote the youth camp. I understand that the images may be used in print publications, online publications, presentations, websites, and social media. I also understand that no royalty, fee or other compensation shall become payable to me by reason of such use.

Medical Release and Authorization

As Parent and/or Guardian of the named camper, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed.

Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment and/or x-ray examination for the named camper. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact me in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach me.

Permission is also granted to the God's Missionary Youth Camp and its affiliates including Directors, Coaches, and Adult Staff to provide the needed emergency treatment prior to the child’s admission to the medical facility.

Release authorized on the dates and/or duration of the registered season.

This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named minor child, in my absence.

Confirmation

BY ACKNOWLEDGING AND SUBMITTING THE FORM, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

Payment

Registration Fee 80.00
Preregistration -10.00
Coupon
Total: 80.00