Family Camp Application

FAMILY UNITED

Finding Your Family's Mission

July 16-18, 2021

YOUTH WITH A MISSION CHICO

Parent/Guardian#1*

First Name

Last Name

Parent/Guardian #2

First Name

Last Name

Address*

Address Line 1

City

State

ZIP Code

Address

Address Line 1

City

State

ZIP Code

Phone*

Phone

Email*

Child's Name & Age

Food Allergies

Emergency Contact Information

Emergency Contact*

First Name

Last Name

Relationship to you*

Primary Phone*

Secondary Phone

Email*

Health information

Answers to these questions will not disqualify you but will provide important information we need to best serve you when you come.

Please list any allergies you have. N/A if none.*

Please list any physical limitations you may have. N/A if none.*

Payment Information

1. Camp Registration must be paid in full to secure spot.

2. Camp Registration will be refunded in full only if canceled 14 days prior to the start of camp.

3. No refunds will be given if a family withdraws from camp for any reason once camp has started.

# ADULTS @ $175/EACH

# TEENS (13-17) @ $100/EACH

# KIDS (5-12) @ $50/EACH

# UNDER 4 FREE

Release of Liability

Signature

[clear]

Use your mouse or finger to draw your signature above

Consent to Treatment

Signature

[clear]

Use your mouse or finger to draw your signature above

Photo/Testimony Release

Signature

[clear]

Use your mouse or finger to draw your signature above

Make Payment

Click on "YWAM Chico" below to make payment and then return here to submit form.

On payment page chose "YWAM Chico Event;

Project: "Family Unified Camp",

Event: Family Camp 2021

One Time Payment

YWAM Chico