2025 Young Men’s Encampment

PARTICIPANT INFORMATION

Participant First Name *

Participant Last Name *

Gender *

Male

Female

Registration Type *

Youth

Adult

Date of Birth *

Age *

Ward *

Primary Phone *

Primary Phone Type *

Home

Cell

Work

Email *

Secondary Phone

Secondary Phone Type

Home

Cell

Work

Address *

Address

City

State/Province

Zip/Postal

Emergency Contact Name (Parent or Guardian) *

Primary Phone *

Primary Phone Type *

Home

Cell

Work

Secondary Phone

Secondary Phone Type

Home

Cell

Work

MEDICAL INFORMATION

Does the participant Require a Special Diet? *

Yes

No

If yes, please explain dietary restrictions

Does the participant have any allergies? *

Yes

No

If yes, please list the allergies

Is the participant taking any medication or over-the-counter (OTC) drugs? *

Yes

No

If yes, can the participant self-administer his or her medication? *

Yes

No

If no, please contact the event or activity leader directly

List all prescription or over-the-counter (OTC) medications the participant is taking *

PHYSICAL CONDITIONS THAT LIMIT ACTIVITY

Does the participant have a chronic or recurring illness? *

Yes

No

If yes, please explain

Has the participant had surgery or a serious illness in the past year? *

Yes

No

If yes, please explain

Identify any other limits, restrictions, or disabilities that could prevent the participant from fully participating in the event or activity

OTHER ACCOMMODATIONS OR SPECIAL NEEDS

Identify any other needs or considerations the participant has that the event or activity planner should be aware of

PERMISSION AND MEDICAL RELEASE

Permission & Medical Release *

I Agree

I give permission for my child/youth to participate in the event and activities listed above (unless noted) and authorize the adult leaders supervising this event to administer emergency treatment to the above-named participant for any accident or illness and to act in my stead in approving necessary medical care. This authorization shall cover this event and travel to and from this event.
The participant is responsible for his or her own conduct and is aware of and agrees to abide by Church standards, camp, or event safety rules and other pertinent instructions. Participants’ conduct and interactions should abide by Church standards and exemplify Christlike behavior.
Parents and participants should understand that participation in an activity is not a right but a privilege that can be revoked if they behave inappropriately or if they pose a risk to themselves or others.

Covid-19 Acknowledgement *

I Agree

Under Georgia law, there is no liability for an injury or death of an individual attending this event if such injury or death results from the inherent risks of contracting COVID-19. You are assuming this risk by attending this event.

Electronic Signature Consent: The parties agree that this registration, permission, and medical release may be electronically signed. The parties agree that the electronic signatures appearing herein are the same as handwritten signatures for the purposes of validity, enforceability, and admissibility.

Participant Signature *