Camper Form 2022 – Nebraska Youth Camp

Date/Time
Date(s) - June 5, 2022 - July 30, 2022

Please enter proper grade and gender information.
If this information is entered incorrectly, registration will be invalidated.

Each camper must be registered and checked out individually.
Come back to this page after checkout if you need to register more than one camper.

Medical Form needs to be filled out and signed 2-3 weeks before session and brought to camp on Registration Day.

If you have difficulty paying for camp you can apply for a scholarship

Ticket Type	Spaces
Registration Form

Parent First Name *

Parent Last Name *

Parent Phone *

Alt Phone

Camper Full Name *

Completed Grade Level *

DOB MM\DD\YYYY *

Sex *

Cabin Mate (for Beg & Jr. only)

Home Congregation

Shirt Size *

Address *

Address Line 2

City/Town *

State/County *

Zip/Post Code *

Camper Phone

Camper Email

Check if we need to contact you about special foods or other accommodations

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