Camp Yadah

2012 Application and Release Form

Senior Camp (ages 13 & up) June 4-8

Junior Camp (ages 6-12) June 12-15

Pre-registration for counselors is required, deadline is May 14, 2012. Counselors must be willing to attend a pre-camp training and workshop. All councelors must be approved by the Camp Yadah Staff. Minimum age for Camp Counselors is 21 years. Minimum age for Jr-Counselors is 15 years. No registration fee for counselors! Must be willing to work!

Select your Camp Select One Senior Junior

First Name Last Name Birthday

Mailing Address

City State Zip

Phone Number Emergency/Work Phone Number

Email AddressGender Select One Male Female

Allergies/Medications

Insurance Company Policy #

Camp Yadah insurance for counselors begins where yours terminates. In the event that you have no insurance, the camp insurance will provide coverage up to policy limits subject to policy provisions.

Pastor's NamePastor's Phone

Church Name

Church Address

City State Zip

Counselors may reserve a Camp Yadah T-Shirt for $15.

Select your T-Shirt Size Select One Youth Small Youth Medium Youth Large Adult Small Adult Medium Adult Large Adult X-Large Adult XX-Large I do not want a T-shirt