Youth Camp Registration

Camper Name *

First

Last

Camper Age Group (in the fall) *

Indicate the camper's school grade in Fall 2021.

Does the camper have any known allergies? *

If Yes for allergies, indicate specific allergy:

Has the camper attended Genesis Youth Camp before? *

Please enter the name of the parent or guardian who should be contacted in the case of an emergency.

Relationship *

Name *

First

Last

Email *

Address

Address Line 1

Address Line 2

City

State

Zip Code

Questions or Comments

Stripe Credit Card

Card

Name on Card

Credit Card Payment is Optional

Checkbox Items

Categories