Camp Registration Form

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RYN Summer Camp 2024
Registration Form

June 28 - July 1
Bongiorno Conference Center
Carlisle, PA

Parent Information

First name

Last name

Email

Phone

Student Information

Student First name

Student Last name

Grade

Student Medical Information

Is your student currently taking any medication that they will need to bring along? *

Yes

No

If yes, which medication(s)?

Medication will be collected and distributed by the camp nurse while at camp.

Please check all that apply to your student

Asthma

Frequently Upset Stomach

Epilepsy or Seizures

Physical Handicap

Heart Troubles

Diabetes

Anxiety/Depression

None of the above

Permission & Medical Release

I give my permission for my student to attend PennDel Youth Camp 2024.

I understand the possibility of unforeseen hazards and know the inherent possibility of risk.

I agree not to hold Refuge Youth Network, its leaders, employees and volunteer staff liable for damages, losses, diseases, or injuries incurred by the subject of this form.

I understand that if my student does not follow the guidelines given at camp and listed in detail on the previous page, they will be asked to return home per my own cost.

My student and I have read and understand all of the rules, guidelines, and regulations provided on refugeyouthnetwork.org/camp

Thanks for registering. See you at camp!

June 28 - July 1

814-889-9113

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RYN Summer Camp 2024 Registration Form