EmailMe Form - Camp Application Form

The camp I am applying for: *

NIKO Endurance camp

Kid's Summer camp, 8-12

Name of Applicant *

First Last

Photo of Camper

Gender *

Male

Female

Date of Birth *

MM / DD / YYYY

Parent/Guardian name *

Parent/Guardian Contact# *

### - ### - ####

Guardian Email address: *

T-Shirt size

For liability and accountability purposes, we require all campers to abstain from romantic relationships for the duration of their stay with us.

I agree

Disagree

YWAM reserves the right to refuse acceptance on the basis of non-compliance of the rules set by the organisation.

I agree

Disagree

Church Information

For all fields that are not relevant, please fill in "N/A" as leaving mandatory slots blank will result in form being rejected.

Name of the Church you attend *

Pastor's Name *

How long have you attended? *

Church Contact Info: Phone or Email *

RELATIONSHIP WITH GOD

Are you a practicing Christian? *

Yes

No

Unsure

If you answered yes above, please describe your conversion experience.

Please note that not being a christian does not disqualify you from attending any of our camps.

HEALTH HISTORY

Please complete this Health History questionnaire to the best of your ability. All answers will be strictly confidential.

Are you in good health *

yes

no

on and off

Are you taking any kind of medication? *

yes

no

on and off

If yes, specify your condition and treatment below.

If you answered yes to being under medical treatment, please explain here.

Do you -OR- have you had any of the following? Click all that apply. *

Are you allergic to any medications? *

Do you have any major allergies we should be mindful of? *

Liability Waivers and Permissions

This Consent section of the form is to be filled out by the responsible adult, parent/guardian for applicant, regardless of campers age.

All accepted campers will have their parents or guardians contacted regarding the consent portions of the form to verify agreement to abide by our policies.

I certify that the information that I provided is correct and for my own benefit and that this information will be strictly confidential and will only be used by the Youth With A Mission staff. If I omit information or state incorrect information, I will not hold Youth With A Mission (YWAM) or its staff responsible for any damage or disciplinary action deemed necessary. Youth With A Mission reserves the right for admission or suspension if you do not meet these requirements.

I agree

I disagree

Camper fills out this portion

CONSENT FOR TREATMENT - I authorize medical treatment and/or surgery and/or the use of anesthesia for my child/ward in the case that, in the opinion of the Physician, it becomes necessary to intervene on their behalf. I, through this medium, authorize the leaders of Access Camp/Youth With A Mission of Montego Bay, Jamaica to seek medical attention for my child/ward.

I agree

I disagree

Responsible adult expected to fill this portion out

CONSENT FOR DISCIPLINE - I understand these camps are run by a Christian Organisation and run according to biblical values. If my child violates the standards of commitment of Youth With A Mission, as expressed in their literature, I understand that the leadership of this camp will send my child home at my expense, and thus also forfeit the cost of the camp.

I agree

I disagree

Responsible adult expected to fill this portion out.