Teen Camper Application Form

Philly Teen Camp 2019 Camper Application

Sunday, June 23rd - Friday, June 28th

Application Deadline: May 21, 2019. Cost: $290 per person. Apply by May 13th for a discount of $15.00. Camp Orchard Hill, Dallas PA Jr & Sr High Camp is happening during the same week. $35 Late Fee will be applied to applications received after June 3, 2019. $125.00 non-refundable deposit due with application. (Balance due at camp)

Camper Information

Housing will be separated in 2 groups: 6th-8th grade & 9th-12th grade

Medical Information

Medication, Food, Etc.
All medication should be packed in a zip lock bag and labeled with camper's name and instructions.
Drop a file here or click to upload Choose File
Maximum upload size: 134.22MB

Parent/Guardian Information

Emergency Contact Information

Other Than Parent/Guardian

Camp Rules & Guidelines

Teen Camp is designed to be a time to “Unplug” from distractions and routines, and Connect to the Lord in a unique way. To minimize those distractions, Campers may not bring any electronics (radios, ipods, MP3 players, CD players, DVD players, TVs, computers, video game players of any type, cell phones, etc.), fireworks, matches/lighters, knives, firearms, alcohol, drugs, tobacco products, etc. Possession of any of these items is sufficient grounds for dismissal from camp. Dress should be modest and appropriate at all times. Swimsuits must be one piece; no TANK TOPS or SPAGHETTI STRAP SHIRTS for FEMALES; shorts must be modest in length; no belly shirts; etc. No undergarments should be showing…at any time. I have read the above Camp rules and I agree to obey all these rules (as well as those set by the Director at the start of camp) while at Camp. I understand that my failure to do so may result in my expulsion from camp at my parents’ expense. I UNDERSTAND THAT I AM NOT TO HAVE A CELL PHONE AT CAMP.

Camper Signature

Parent/Guardian Signature

I realize that children can become injured at camp. I hereby assume all risk of injuries to my child and hereby release and discharge Philadelphia District NYI and Camp Orchard Hill from any and all liability which may result in injury to my child. In consideration of the privilege of my child’s participation in Teen Camp, and on behalf of my child and me as parent/guardian, I hereby release, discharge, hold harmless and indemnify, and covenant not to sue, the Philadelphia District NYI, Camp Orchard Hill, and all Youth Ministries Staff, officers, trustees, ministers, employees, volunteers, insurers, agents and representatives, and all other persons associated with the Philadelphia District NYI Program, as to any and all claims of my child, me and other family members for personal injuries suffered by my child, property damage, medical expenses, and economic loss arising directly or indirectly out of my child’s participation in the Program, and any first aid, medical care or treatment provided to my child in the event my child is injured or becomes ill while participating in Program activities. I am the legally responsible parent or guardian of my child. I future agree that insurance protection is my responsibility. I give permission for the camp to administer medications as it seems necessary to my child, including medication sent with my child or non-prescription medications available at the camp. In case of emergency, I understand that every effort will be made to contact me. In the event I cannot be reached, I hereby give my permission to the physician selected by the camp administration to hospitalize and secure professional treatment (including surgery) for my child. I give my permission for free use of my child’s name and picture in Church pictures, videos, and publications for any participation in a Philadelphia. District NYI sponsored event. I assume financial responsibility for all actions of my child, which may include damage to property or the personal possessions of others. If the staff deems it necessary for my child to be removed from camp due to disciplinary or other problems, I will respond promptly by picking up my child. I realize that the Philadelphia District NYI and Camp Orchard Hills cannot be held responsible for my child’s possessions, and therefore will not send him/her with any valuables. I agree to the above terms. In addition, I understand that my child must obey all the camp rules, and his/her failure to do so may result in early expulsion from camp at my expense.

$125 Deposit Due At Signing

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