register

2024 Registration

We can accommodate up to 85 campers. Acceptance is based on registration (a first come, first served basis). Anyone who registers in the required way and agrees to abide by the camp rules may attend. No one shall be denied because of race, color, national origin, sex, or handicap.

Campers can either register through the online form provided below or by downloading and returning a .pdf version of the form here.

Cost for registration by cash/check is $125 ($130 by PayPal)

Register Online

Desired Date(s)

June 16-21 (Senior Week , Ages 14-19) June 23-28 (Intermediate Week, Ages 11-14) June 30-July 5 (Junior Week, Ages 8-11)

Parent/Guardian

Emergency Contact

Camper

Gender

Male Female

Date of Birth

Age

Grade in Fall

Mailing Address

City

State

Zip Code

Home Phone

Home Congregation

Member?

Yes No

Optional T-Shirt ($15)

Youth S Youth M Youth L Adult S Adult M Adult L Adult XL

Father's Name

Father's Home #

Father's Cell #

Mother's Name

Mother's Home #

Mother's Cell #

Family Doctor

Family Doctor's #

Allergies

Medication

Please check medications the nurse can give your child

Tylenol Benadryl Aspirin Tussin DM Laxative Pepto Bismol Ibuprofen Aleve Midol Sinus Tablets

Additional medications the nurse can give your child

Other Medical Information (Including Restrictions)

I authorize the following individuals to pick up my child

The following individuals are NOT authorized to pick up my child

Please list important information that the counselors/staff should know about your child (e.g., attention problems, extremely shy, afraid of the dark, bed wetting, needs to be kept separate from another camper (add name), or other issues)

Special requests to be assigned to the same section of the dorm as two other campers/counselors

Release of Liability

I hereby authorize Ohio Valley Christian Youth Camp, Inc. to arrange for my child whatever medical or emergency treatment may be necessary while my child is at camp. I realize there are certain risks associated with camping. As a camper/parent of a camper, I accept full responsibility for personal injury/illness and loss/damage to personal property incurred during or as a result of camping. I will not hold Ohio Valley Christain Youth Camp, Inc. liable for any of the above.

Photo Release

I hereby grant the Ohio Valley Christian Youth Camp permission to use my likeness in a photograph, video, or other digital media (“photo”) in any and all of its publications, including web-based publications, without payment or other consideration. I understand and agree that all photos will become the property of the Ohio Valley Christian Youth Camp and will not be returned. I hereby irrevocably authorize the Ohio Valley Christian Youth Camp to edit, alter, copy, exhibit, publish, or distribute these photos for any lawful purpose. In addition, I waive any right to inspect or approve the finished product wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photo. I hereby hold harmless, release, and forever discharge the Ohio Valley Christian Youth Camp from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization.

Electronic Signature (Full Legal Name)

740.336.6860 | becdavis0826@gmail.com