Registration

Camp 2023 is July 16-22

Cost: $365 (plus any transportation charges assessed by your church)

You can register for camp using the online form below.

Camp Registration 2023

Registration Type*
- Camper
- New Counselor / Staff
- Returning Counselor / Staff
Name*
First Last
Gender*
- Male
- Female
Age*
Grade in September*
Age Group*
- Juniors (from going into 3rd grade to going into 6th grade)
- Junior High (from going into 6th grade to going into 9th grade)
- Senior High (from going into 9th or grade to high school graduate)
- College (from high school graduate to college graduate)
Parent's / Guardian Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Alternate Phone
Email*
Cabin-mate Request
Church You're Registering With*
Other Church City
Emergency Contact Name*
First Last Relationship
Emergency Contact Phone*
Physical limitations that require accommodations
Diet Restrictions
Allergies
Current Medications w/ Dosage
Have you had a Tetanus shot in last 10 years? (if under 18 years old)
- Yes
- No
The stock meds on hand are Tylenol, Ibuprofen, OTC Cough Syrup, Dramamine, OTC Antihistamine, and OTC Anti-diarrheal. Also available are sunscreen, insect repellant, and anti-itch preparations. Epi-Pens or injectable adrenaline is available in case of sever allergic reaction. This would be administered after verbal contact with a doctor or medical care facility. Please indicate below which of these your child is NOT to receive.
Prohibited Medications
Any other restrictions
(swimming, rifles, health related restrictions to make known to nurses, etc.)
Family Physician
Physician Phone
Name of Insurance
Insurance ID #
Insurance Group #
Insurance Cardholder
Parental Consent For Participation – Release Of Liability And Medical Release For A Minor I, the undersigned, represent that I have full authority to enter into this consent and waiver on behalf of this minor child and understand that every effort will be made to protect and safeguard all participants in the WESTERN REGION GRACE YOUTH CAMP program. I request that the above named child be permitted to participate in the conference group’s program activities scheduled from July 14th to July 20th, 2019 and HEREBY WAIVE ALL CLAIMS WHICH I/WE MIGHT HAVE AGAINST WESTERN REGION GRACE YOUTH CAMP, THE PALOMAR MOUNTAIN CHRISTIAN CONFERENCE CENTER, their officers, agents, and employees for injury, accident, illness, or death occurring during or by reason of the activity, and I/we further agree to identify and save free harmless Western Region Grace Youth Camp, the Palomar Mountain Christian Conference Center, their officers, agents and employees against claims, liabilities, penalties, or loss resulting from consequences of said activity. In case of medical emergency I hereby give permission to the physician’s/medical personnel selected to hospitalize, secure treatment for, and order injections, anesthesia, or surgery as deemed necessary by attending medical personnel for the herein named. I also give permission to Palomar Christian Conference Center to use any photographs and videos of the above named minor for promotional materials, including the WCGYC AND PCCC web sites postings, without expectation of compensation.
Parent / Guardian Signature*
By inputting your name and date in the field below, you are electronically signing this document. By electronically signing this, you acknowledge that all information is filled out accurately to the best of your knowledge, and if applicable, that you are giving permission for your child/dependent to attend West Coast Grace Youth Camp.
Name Date
Camper Signature*
As a camper at the Western Region Grace Youth Camp, I will agree to cooperate with the directors and my counselors, including the dress code. I promise to cooperate fully with the camp program so that I will gain all the benefits planned for me. I give my word that I will respect other people and their property. I understand that if I do not cooperate I may be sent home at my parents’ expense.
Name Date
Volunteer Role*
- Cabin Counseling
- Staff (I have been assigned a staff role by the camp director)
Which age group would you like to counsel?*
- Junior (3rd-6th grade)
- Junior High (6th-9th grade)
- Senior High (9th-High school graduate)
- College (High school graduate to college graduate)
List any physical limitations and/or medications
Do you have any first aid training?
- Yes
- No
Are you CPR certified?
- Yes
- No
Please list any additional skills or experiences that may be helpful at camp.
Please supply a brief testimony; when and how you were saved.
How does being a Christian effect your daily life?
What ministries are you involved in at your local church?
Summarize what you tell a camper who wanted to know how to become a Christian, include Bible references.
Are you comfortable with the following responsibilities as a counselor?
~ General cabin unity and cleanliness
~ Cabin devotions every morning and evening
~ Full participation in all games and activities
~ One on One time with each camper in your cabin
~ The statement: “I have accepted Christ as my personal savior and seek to use this opportunity to minister to campers in my care. I will be a faithful example, counselor and guide to the end that Jesus Christ will be glorified and honored. I understand the doctrinal position of the Grace Gospel Fellowship and the duties and responsibilities of being a counselor.”
- Yes
- No
Palomar Christian Conference Center General Release and Waiver of Rights
By clicking “I agree,” you agree by an electronic signature to the terms and agreements laid out in the general release and waiver of rights form. And that if the camper is under the age of 18 when this application is being executed, that the parent or guardian of camper has read and agrees to Palomar Mountain Christian Conference Center’s general release and waiver of rights form.
- I agree
- I do not agree
COVID 19 commitment*
By clicking “I agree,” you agree by electronic signature that you have no recorded fever for 72 hours (recorded daily) leading up to camp and have no symptoms of a cold or flu. You also agree to abide by WCGYC’s rules regarding social distancing and PPE.
- I Agree
- I do not agree
Email
This field is for validation purposes and should be left unchanged.