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Camper Information:

Camper's First Name *

Camper's Last Name *

Gender *

Male
Female
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Address *

City *

State *

Postal code *

Age *

Grade in Fall 2025 *

Date of Birth *

Church Group *

Camper T-Shirt Size (Included in registration) *

Youth S
Youth M
Youth L
Adult S
Adult M
Adult L
Adult XL
Adult XXL
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CAMP WEEK *

Junior Week - July 7-11
Teen Week - Jun 23-28
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Roomate Request (honored if possible)

CAMPER AGREEMENT:

I have read the camp information, including the dress code and the 'do not bring' list. I agree to totally cooperate and comply in all areas. I understand that the primary emphasis of camp is spiritual

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Camper Agreement Signature *

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Camper Agreement Date *

PARENT / GUARDIAN INFORMATION:

Parent's First Name *

Parent's Last Name *

Parent's Email *

Parent's Cell Phone *

Parent's Work Phone *

Med. Insurance Co. *

Policy # *

My Child Is Physically Healthy and Able to Participate in the Camp Program Except: *

Is Camper Taking Medications? *

Yes
No
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Date of Last Tetanus Shot (If none enter unknown) *

Please Note Any Medications, Health Issues, Behavioral, Emotional Problems (including infectious diseases)

Please List Allergies:

If I cannot be reached in an emergency, I hereby give permission to MPACT YOUTH CAMP to accrue proper treatment for the above name child.

Parent / Guardian Signature *

Clear

Parent / Guardian Signed Date *

Sell Products *

2025 Camp Registration (No Snack Shop) T-Shirt Included

$149

2025 Camp Registration w/ $10 Snack Shop (T-shirt Included)

$159

2025 Camp Registration w/ $20 Snack Shop (T-shirt Included)

$169

2025 Camp Registration w/ $30 Snack Shop (T-shirt Included)

$179

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Click Here to View Important Camp Information and Brochure

Pay for Camp BelowIf You Like to Order a T-Shirt or Pre-Pay for the Snack Shop You Can Add Those Below

Payment

ItemQuantityPrice

No products available

T-Shirt - $12

Snack Shop - Prepay - $10

Snack Shop - Prepay - $20

Snack Shop - Prepay - $30

Order Summary

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