2027 Camper Registration

Camper's First Name

Camper's Last Name

Street Address

City

State

ZIP / Postal Code

Birthdate

Month

Day

Year

Gender

Male

Female

Campers will be assigned to the cabin area and will use restrooms/shower facilities of their biological (birth) gender.

Grade completed at the end of the current school year

New Camper (never attended Camp JYC before)

Yes

No

Request one cabin-mate of the same gender

(not required; not guaranteed; N/A for Lil' Squirts Day Camp)

Does the camper require a special diet?

Yes

No

If the camper has special dietary restrictions, please describe below.

If the camper has special needs or circumstances, please describe below.

Parents' or Guardians' Names

Parent/Guardian Phone

Parent/Guardian Email

How did you hear about Camp JYC?

Early Registration (Is it before June 1st?)

Yes

No

Camper T-Shirt Size

Choose your camp(s)!

Lil' Squirts Day Camp - July 8-10

Teen Camp - July 12-17

Discovery Camp - July 19-24

Adventure Camp - July 26-31

Lil' Squirts Day Camp (completed grades K-2; $135/$165)

Teen Camp (completed grades 7-11; $240/$290)

Discovery Camp (completed grades 3-6; $240/$290)

Adventure Camp (completed grades 5-11; $240/$290)

Choose your payment method:

Credit card or digital payment

Check or Money Order payable to Camp JYC

Requesting full or partial sponsorship

Each overnight camper must bring a completed MEDICAL FORM, which includes obtaining a DOCTOR'S SIGNATURE.

I have read and understand the above statement.

This does not apply to me - Lil' Squirts camper only.

Each overnight camper must bring a single sized mattress for their bunk. (Will not apply to campers assigned to our newer cabins. You will receive an email the Saturday prior to your week of camp after cabin assignments have been completed.)

I have read and understand the above statement.

This does not apply to me - Lil' Squirts camper only.

The submission of this registration form gives my child permission to attend Camp JYC, participate in all activities, and receive emergency medical treatment if necessary. It further gives Camp JYC permission to use my child's image in promotional materials.