SD Youth Camp 2024

Name

Parent Name (18 and Under)

Parent Guardian Phone

Address

This address will receive a confirmation email

Have you:

Repented of your sins? Been baptized in Jesus' name? Received the baptism of the Holy Ghost?

Home Church

Has your pastor given you permission to attend youth camp?

Yes No

Payment

Consent and Acknowledgement

I hereby give my approval for my child's participation in any and all activities related to South Dakota Youth Camp. I assume all risks and hazards incidental to the conduct of the activities, and release, absolve, and hold harmless SDYM and its respective representatives from any and all liability. In the case of injury to said child, I hereby waive all claims against SDYM, including all affiliates, all participants, sponsoring agencies, advisers, and owners and lessors of premises used to conduct the event.

Medical release and authorization

I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, in the event of a medical emergency. Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and related procedure for the named child, in the event of an emergency Permission is also granted to SDYM or Byron Bible Camp and its affiliates to provide the needed emergency treatment prior to the child's admission to the medical facility.

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

SD Youth Camp 2024

Description

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