White Eagle Youth Camp – Registration

Parent / Guardian Information

First Name *

Last Name *

Email Address *

Emergency Contact Number *

How many in your family will be attending camp? *

Please fill in the blanks below

Fill out the information for each one in your family attending camp, including adults

Camp Attendee 1

First Name

Last Name

Birthdate

Camp Attendee 2

First Name

Last Name

Birthdate

Camp Attendee 3

First Name

Last Name

Birthdate

Camp Attendee 4

First Name

Last Name

Birthdate

Camp Attendee 5

First Name

Last Name

Birthdate

Camp Attendee 6

First Name

Last Name

Birthdate

Camp Attendee 7

First Name

Last Name

Birthdate

How would you like to pay for camp? *

PayPal or Credit Card

Pay by Check or In Person

Choose the PayPal option to pay online by credit card or with a PayPal account. If you would rather send in a check or pay in person, choose the Check option.

Camp Participation Agreement

I hereby authorize the staff of the White Eagle Youth Camp to act for me according to their best judgement in any emergency requiring medical
attention and I hereby waive and release WMO from any liability for any injuries or illnesses incurred while attending camp.  I have no knowledge of any physical impairment that would be effected by the above camper’s participation in activities at White Eagle Youth Camp.  I will be responsible for any medical charges in connections with his or her attendance at camp.  I also understand that White Eagle Youth Camp retains any right to use photographs of campers taken while at camp.  I have read and agree to the White Eagle Youth Camp Rules and Guildelines and the Camp Participation Agreement in its entirety and I give permission for those listed above to attend camp and participate in activities.

Do you accept the above agreement? *

I accept the agreement

I do NOT accept the agreement

White Eagle Youth Camp – Registration

Parent / Guardian Information

Please fill in the blanks below

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