MT ZION YOUTH CAMP REGISTRATION FORM

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Youth Camp 2023: Psalms 23 - The Lord is my Shepherd

Click Here to View Items Needed/Trip Details

LOCATION(S)

The Springs Ministries, 1950 M-30, Gladwin, MI 48624

DATE(S)

July 31st – August 4th, 2023

COST(S)

$350 – If students provide their own transportation to and from the Campground
$400 – If students ride the bus provided by Mt Zion Church to or from the Campground.

GENERAL INFO

Experience the suprises, games, powerful services, and people that make camp unforgettable. This summer at Mt Zion Youth Camp, come and see why David in the Bible calls out to God and sings, “The Lord is my Shepherd, I shall not want.” We can’t wait to have an awesome week with you and see all that God does! Camp is a week-long event for 7th-12th graders as of the 2023-2024 school year that takes place from Monday, July 31st – Friday, August 4th. To get more info, contact Billy Foster, Sam O’Berry, Gabriel Carnell or fill out our contact form.

YOUTH CAMP 2023 REGISTRATION (STUDENTS 1 & 2)

SIGN-UP IS OFFICIALLY CLOSED AS OF 7/24/23. PLEASE CONTACT PASTOR BILLY IF YOU HAVE NOT SIGNED UP YET AND WOULD LIKE TO.

Mt Zion Youth Camp Registration Form

1st Student's Name *

First

Last

1st Student's Gender *

Male
Female

1st Student's Birth Date *

1st Student's Medical Items (i.e. allergies)

1st Student's Grade Level for 2023-2024 School Year *

1st Student Camp Signup

SIGN-UP IS OFFICIALLY CLOSED AS OF 7/24/23. PLEASE CONTACT PASTOR BILLY IF YOU HAVE NOT SIGNED UP YET AND WOULD LIKE TO.

Select Transportation to Camp *

Roommate Request *

First

Last

1st Student's T-Shirt Size *

Health Records for 1st Student

Please Mark the Immunizations received: (immunizations not required) *

DPT
Tetanus
Polio
TB
Measles
Hepatitis B
German Measles
None of the Above

Please List Allergy Information *

Please describe how the allergy happens, what happens, and what should be done to treat the allergy.

Description of Current Medications student is taking (prescription and non-prescription) ONLY IF IT WILL NEED TO BE BROUGHT TO EVENT *

Please describe the name of the medicine, the reason for the medicine, how much medicine is to be taken, and what time the medicine is to be taken.

Is the student currently being treated for any infectious diseases? *

Please Explain the Infectious Disease situation *

Please select any of the following that the student has *

Panic Attacks
Diabetes
Asthma
Convulsions
Current Injuries
Current illness
Behavioral Problems
Physical limitations
Other
None of the above

Please describe what should be done for above situation and how medication should be given if needed

Physician's Name *

Physician's Phone Number *

Insurance Company *

Should you have no insurance provider, please indicate “none”

Name of Insured *

Should you have no insurance provider, please indicate “none”

Policy Number *

Should you have no insurance provider, please indicate “none”

Would you like to sign-up a second student? *

2nd Student

2nd Student's Name *

First

Last

2nd Student's Gender *

Male
Female

2nd Student's Birth Date *

2nd Student's Medical Items (i.e. allergies)

2nd Student's Grade Level for 2023-2024 School Year *

2nd Student Camp Signup

SIGN-UP IS OFFICIALLY CLOSED AS OF 7/24/23. PLEASE CONTACT PASTOR BILLY IF YOU HAVE NOT SIGNED UP YET AND WOULD LIKE TO.

Select Transportation to Camp *

10% Discount for all students of a single family, after the first student

Roommate Request *

First

Last

2nd Student's T-Shirt Size *

Health Records for Second Student

Please Mark the Immunizations received: (immunizations not required) *

DPT
Tetanus
Polio
TB
Measles
Hepatitis B
German Measles
None of the Above

Please List Allergy Information *

Please describe how the allergy happens, what happens, and what should be done to treat the allergy.

Description of Current Medications student is taking (prescription and non-prescription) ONLY IF IT WILL NEED TO BE BROUGHT TO EVENT *

Please describe the name of the medicine, the reason for the medicine, how much medicine is to be taken, and what time the medicine is to be taken.

Is the student currently being treated for any infectious diseases? *

Please Explain the Infectious Disease situation *

Please select any of the following that the student has *

Panic Attacks
Diabetes
Asthma
Convulsions
Current Injuries
Current illness
Behavioral Problems
Physical limitations
Other
None of the above

Please describe what should be done for above situation and how medication should be given if needed

Physician's Name *

Physician's Phone Number *

Insurance Company *

Should you have no insurance provider, please indicate “none”

Name of Insured *

Should you have no insurance provider, please indicate “none”

Policy Number *

Should you have no insurance provider, please indicate “none”

Total Cost for Event Registration for Students 1 & 2

$ 0.00

PARENT INFORMATION

Parent Name *

First

Last

Address *

City *

State *

Zip Code *

Primary Phone *

Mom's Cell Phone

Dad's Cell Phone

Email Address *

Alternate Email Address

Do You Attend Mt. Zion Church *

MT ZION YOUTH EVENTS WAIVER (REQUIRED)

I give Mt. Zion and its assigns the irrevocable right to use graphic images such as photographs, video, and digital pictures of the enrolled student taken in past, and future gatherings on and off the premises for advertisement and instructional purposes. Advertisements include, but are not limited to, print media, web, and social networks such as Facebook and Twitter. I hereby release and agree to hold harmless Mt. Zion and its assigns from any liability by virtue of any blurring, distortion, alteration, or use in composite form whether intentional or otherwise that may occur in the taking or processing of the photographs. I hereby assume responsibility, and release Mt. Zion, its employees, sponsoring organizations, etc. from all responsibility for my child if he/she leaves the building for any purpose I hereby assume all responsibility for myself and for my children while participating in activities sponsored by Mt. Zion. I acknowledge that participation in the activities offered by Mt. Zion involves risk to the participant (and to the participant’s parents or guardians, if the participant is a minor), and may result in various types of injury including, but not limited to, the following: sickness, exposure to infectious/communicable disease, bodily injury, death, emotional injury, personal injury, property damage, and financial damage. I waive all claims for liability against Mt. Zion, its employees/instructors, its assigns in case of injury. I authorize Mt Zion to approve medical treatment. I release and promise to indemnify, defend, and hold Mt. Zion harmless for any injury arising directly or indirectly out of participation in Mt. Zion events. I am of legal age, or the parent or legal guardian of the enrolled student(s). SIGN BELOW *

PAYMENT INFORMATION

I understand to confirm my registration and event enrollment requires Mt. Zion to receive my payment in full (cash, Zelle, or check only), to receive a signed waiver, and to receive full insurance information. Choose between the options below to submit payment:

Payment Method (Choose One) *

Drop off at Mt Zion Reception Desk from 9am to 5pm on Mondays – Fridays
Pay with Zelle to events@mtzion.org with a memo stating “Youth Camp 2023”
Give to Pastor Billy, Sam O’Berry, or Gabriel Carnell at any service, class, or event.

Be sure to check your email for information regarding the Youth events.

Do you have additional students to register? If you have more than two students, please submit and continue on to the "3rd and 4th Student" registration form.

YOUTH CAMP 2023 REGISTRATION (STUDENTS 3 & 4)

SIGN-UP IS OFFICIALLY CLOSED AS OF 7/24/23. PLEASE CONTACT PASTOR BILLY IF YOU HAVE NOT SIGNED UP YET AND WOULD LIKE TO.

Did you already fill out the "Registration for students 1 & 2" form? *

Please use the "Registration Form for Students 1 and 2" above to sign-up the first two students before using this form for Students 3 and 4

INFORMATION FOR THE FIRST TWO STUDENTS

1st Student's Full Name *

First

Last

2nd Student's Full Name *

First

Last

Mt Zion Youth Camp Registration Form

3rd Student's Name *

First

Last

3rd Student's Gender *

Male
Female

3rd Student's Birth Date *

3rd Student's Medical Items (i.e. allergies)

3rd Student's Grade Level for 2023-2024 School Year *

3rd Student Camp Signup

SIGN-UP IS OFFICIALLY CLOSED AS OF 7/24/23. PLEASE CONTACT PASTOR BILLY IF YOU HAVE NOT SIGNED UP YET AND WOULD LIKE TO.

Select Transportation to Camp *

10% Discount for all students of a single family, after the first student

Roommate Request *

First

Last

3rd Student's T-Shirt Size *

Health Records for 3rd Student

Please Mark the Immunizations received: (immunizations not required) *

DPT
Tetanus
Polio
TB
Measles
Hepatitis B
German Measles
None of the Above

Please List Allergy Information *

Please describe how the allergy happens, what happens, and what should be done to treat the allergy.

Description of Current Medications student is taking (prescription and non-prescription) ONLY IF IT WILL NEED TO BE BROUGHT TO EVENT *

Please describe the name of the medicine, the reason for the medicine, how much medicine is to be taken, and what time the medicine is to be taken.

Is the student currently being treated for any infectious diseases? *

Please Explain the Infectious Disease situation *

Please select any of the following that the student has *

Panic Attacks
Diabetes
Asthma
Convulsions
Current Injuries
Current illness
Behavioral Problems
Physical limitations
Other
None of the above

Please describe what should be done for above situation and how medication should be given if needed

Physician's Name *

Physician's Phone Number *

Insurance Company *

Should you have no insurance provider, please indicate “none”

Name of Insured *

Should you have no insurance provider, please indicate “none”

Policy Number *

Should you have no insurance provider, please indicate “none”

Would you like to sign-up a fourth student? *

4th Student

4th Student's Name *

First

Last

4th Student's Gender *

Male
Female

4th Student's Birth Date *

4th Student's Medical Items (i.e. allergies)

4th Student's Grade Level for 2023-2024 School Year *

4th Student Camp Signup

SIGN-UP IS OFFICIALLY CLOSED AS OF 7/24/23. PLEASE CONTACT PASTOR BILLY IF YOU HAVE NOT SIGNED UP YET AND WOULD LIKE TO.

Select Transportation to Camp *

10% Discount for all students of a single family, after the first student

Roommate Request *

First

Last

4th Student's T-Shirt Size *

Health Records for 4th Student

Please Mark the Immunizations received: (immunizations not required) *

DPT
Tetanus
Polio
TB
Measles
Hepatitis B
German Measles
None of the Above

Please List Allergy Information *

Please describe how the allergy happens, what happens, and what should be done to treat the allergy.

Description of Current Medications student is taking (prescription and non-prescription) ONLY IF IT WILL NEED TO BE BROUGHT TO EVENT *

Please describe the name of the medicine, the reason for the medicine, how much medicine is to be taken, and what time the medicine is to be taken.

Is the student currently being treated for any infectious diseases? *

Please Explain the Infectious Disease situation *

Please select any of the following that the student has *

Panic Attacks
Diabetes
Asthma
Convulsions
Current Injuries
Current illness
Behavioral Problems
Physical limitations
Other
None of the above

Please describe what should be done for above situation and how medication should be given if needed

Physician's Name *

Physician's Phone Number *

Insurance Company *

Should you have no insurance provider, please indicate “none”

Name of Insured *

Should you have no insurance provider, please indicate “none”

Policy Number *

Should you have no insurance provider, please indicate “none”

Total Cost for Event Registration for Students 3 & 4

$ 0.00

PARENT INFORMATION

Parent Name *

First

Last

Address *

City *

State *

Zip Code *

Primary Phone *

Mom's Cell Phone

Dad's Cell Phone

Email Address *

Alternate Email Address

Do You Attend Mt. Zion Church *

MT ZION YOUTH EVENTS WAIVER (REQUIRED)

PAYMENT INFORMATION

I understand to confirm my registration and event enrollment requires Mt. Zion to receive my payment in full (cash, Zelle, or check only), to receive a signed waiver, and to receive full insurance information. Choose between the options below to submit payment:

Payment Method (Choose One) *

Drop off at Mt Zion Reception Desk from 9am to 5pm on Mondays – Fridays
Pay with Zelle to events@mtzion.org with a memo stating “Youth Camp 2023”
Give to Pastor Billy, Sam O’Berry, or Gabriel Carnell at any service, class, or event.

Be sure to check your email for information regarding the Youth events.

MT ZION NEWS

Sign-up to receive our weekly e-newsletter and stay up-to-date with our latest news and events happening at Mt Zion!

NAME *

First

Last

EMAIL *

Name

MT ZION YOUTH CAMP REGISTRATION FORM

LOCATION(S)

DATE(S)

COST(S)

GENERAL INFO

SIGN-UP IS OFFICIALLY CLOSED AS OF 7/24/23. PLEASE CONTACT PASTOR BILLY IF YOU HAVE NOT SIGNED UP YET AND WOULD LIKE TO.

Mt Zion Youth Camp Registration Form

1st Student Camp Signup

SIGN-UP IS OFFICIALLY CLOSED AS OF 7/24/23. PLEASE CONTACT PASTOR BILLY IF YOU HAVE NOT SIGNED UP YET AND WOULD LIKE TO.

Health Records for 1st Student

2nd Student

2nd Student Camp Signup

SIGN-UP IS OFFICIALLY CLOSED AS OF 7/24/23. PLEASE CONTACT PASTOR BILLY IF YOU HAVE NOT SIGNED UP YET AND WOULD LIKE TO.

Health Records for Second Student

PARENT INFORMATION

MT ZION YOUTH EVENTS WAIVER (REQUIRED)

PAYMENT INFORMATION

I understand to confirm my registration and event enrollment requires Mt. Zion to receive my payment in full (cash, Zelle, or check only), to receive a signed waiver, and to receive full insurance information. Choose between the options below to submit payment:

Be sure to check your email for information regarding the Youth events.

Do you have additional students to register? If you have more than two students, please submit and continue on to the "3rd and 4th Student" registration form.

SIGN-UP IS OFFICIALLY CLOSED AS OF 7/24/23. PLEASE CONTACT PASTOR BILLY IF YOU HAVE NOT SIGNED UP YET AND WOULD LIKE TO.

Please use the "Registration Form for Students 1 and 2" above to sign-up the first two students before using this form for Students 3 and 4

INFORMATION FOR THE FIRST TWO STUDENTS

Mt Zion Youth Camp Registration Form

3rd Student Camp Signup

SIGN-UP IS OFFICIALLY CLOSED AS OF 7/24/23. PLEASE CONTACT PASTOR BILLY IF YOU HAVE NOT SIGNED UP YET AND WOULD LIKE TO.

Health Records for 3rd Student

4th Student

4th Student Camp Signup

SIGN-UP IS OFFICIALLY CLOSED AS OF 7/24/23. PLEASE CONTACT PASTOR BILLY IF YOU HAVE NOT SIGNED UP YET AND WOULD LIKE TO.

Health Records for 4th Student

PARENT INFORMATION

MT ZION YOUTH EVENTS WAIVER (REQUIRED)

PAYMENT INFORMATION

I understand to confirm my registration and event enrollment requires Mt. Zion to receive my payment in full (cash, Zelle, or check only), to receive a signed waiver, and to receive full insurance information. Choose between the options below to submit payment:

Be sure to check your email for information regarding the Youth events.

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