What is your full name?
What is your date of birth?
What is your home address?
What is your phone number?
What is your email?
Leader/Worker Information
Group leaders must be saved, sanctified, and filled with the Holy Ghost. General workers must be at a minimum saved and sanctified or actively pursuing a sanctified lifestyle. Each individual should strive to live and maintain a lifestyle of Holiness.
Please check all that apply regarding your current spiritual status.
Please select the areas you desire to work in below:
What size?
Church Information
Emergency Contact
Do you have any dietary restrictions?
Do you have any allergies?
Any known health problems or physical limitations?
Are you currently taking any medications?
Are you able to administer medication without assistance?
If needed, can the Heritage Camp Directors or their authorized representatives administer pain medication?
Do you have medical insurance?
I recognize that there may be occasions where I or my child, if a participant, may be in need of first aid or emergency medical treatment as a result of an accident, illness, or other health condition or injury. I do hereby give permission for the Heritage Camp Directors to seek and secure any needed medical attention or treatment for my child or myself, including hospitalization, if the need arises. I agree that Heritage Youth camp is not responsible for fees or costs arising from the action to obtain medical treatment for my child or myself. I give permission to the physicians and other medical personnel to administer any needed medical treatment , x-rays, injections, anesthesia, hospitalization, I-V's, blood transfusions, medications, and surgery for my child or myself.
By signing below, I acknowledge that the information provided is accurate and that I agree to follow camp policies and directions from camp leadership.
