Heritage Youth Camp

What is your full name?

What is your date of birth?

What is your home address?

Parent's Phone Number:

Parent's Email:

Shirt Preference Would you like a short sleeve or long sleeve shirt?

Church Information Do you attend a church?
Yes No

Emergency Contact Name:

Emergency Contact Number:

Do you have medical insurance?

Yes No

First Aid & Consent Agreement

I authorize Heritage Youth Camp staff to seek emergency medical treatment if needed. I assume full responsibility for costs incurred. I also agree to follow all camp rules and hold Heritage Youth Camp harmless in the case of injury or illness due to my own actions.

I agree to the terms above and will follow the camp rules (view camp rules).

For Heritage Youth Camp 2026, the cost is $125 per camper or worker. This fee helps cover the costs of hosting camp and providing a great experience for everyone involved.

Checks are preferred and should be made payable to Heritage Youth Camp, with “2026” written in the memo line. Payments may be mailed in advance to:

Heritage Youth Camp
4869 Wilson’s Mills Rd.
Clayton, NC 27520

Please note, payments can be mailed until May 1, 2026. After this date, payments will be accepted on the first day of camp during arrivals.

E-Signature:

Date:

Camper Registration