Camper Registration — Merritt Youth Retreat

Before You Register:

Be sure to read our Dress Code Policy and our Sexuality Policy.

View Dress Code Policy

View Sexuality Policy

Camper Registration Form

Camper Information:

Please enter your camper's information below!

Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Email

Emergency Contact Phone

(###)

###

####

Biological Sex

T-Shirt Size

**Please Note** You must register by July 1st to be guaranteed your shirt size.

Grade in Fall 2024

Small Groups

If you attended camp last summer, do you want the same Small Group Leader you had last year?

Yes

No/Does Not Apply

Allergies (including foods) and/or Medical Conditions

Will your camper be bringing medication to camp?

**All campers will be required to turn in their medications to our camp nurse along with the medication name and dosage instructions. (An additional form will be emailed to you prior to camp.)

Transportation to/from Camp

Dean Ostrander Ministries plans to provide transportation to and from camp for those local to Broken Bow. If your camper is in need of a ride from Broken Bow to Davis Creek, please select "Yes" and Kassy will contact you with additional details closer to camp.

Name of Home Church (if any)

Insurance Information:

Please enter your camper's insurance information below. This will be used in the event of an emergency.

Insurance Company

Policy Holder Name

Group or Policy Number

Family Doctor & Phone Number

Terms of Liability & Agreement

By checking this box and typing my name below, I acknowledge that I am the parent/guardian of the previously named child. I also certify that I am at least 18 years of age. I agree to allow my child to attend and participate in all MYR activities occurring July 19-21, 2024. I will not hold Dean Ostrander Ministries liable if my child should contract any illness, including COVID-19, while at camp.

Adherence to DOM Policies

Links to the DOM Dress Code and Sexuality Policy have been included below.

I have read and will adhere to the DOM Dress Code and Sexuality Policy.

Parent/Guardian Signature

By typing your name in this box, you agree to allow your child to attend and participate in all MYR activities occurring July 19-21, 2024.