BREAKAWAY YOUTH CAMP 2022

JULY 18-22  |  CARLINVILLE, IL

All Calvary Youth students and their friends are invited to YOUTH CAMP 2022!

Cost:

$300
Registration must be completed and payment must be made in full by June 29.

One Oasis Camp T-Shirt is included in the price of registration.

Camp T-Shirt - $12
Students may purchase the ISM camp T-shirt at an additional cost while supplies last.

Ropes Course - $30
Students may purchase admission to the ropes course at camp.

Registration closes on June 29. 

 

To register your child for camp, begin by making a payment here. You can choose the deposit only or full payment option. Then, have your child read this code of conduct and fill out the form below.

If your child will require medication to be admistered at camp, please fill out this medication sheet and have them bring it with them on the first day of camp. The Code of Conduct and Medication Sheet will also be included in your camp registration confirmation. 

Please note that you will need to make a payment first in order to complete the online form. 

If you prefer to print, fill out, and turn in your camp packet, click here to print.

 

Sponsor a Student!

If you would like to sponsor a student for camp, please click here. (If you would like to donate an amount not listed, please contact Pastor Michael in the Church Office.)

 

Payment Confirmation


Student Information


Parent/Guardian Information


Health Care Information

Health care field must be completed by a parent or guardian. All medications, prescriptions, and over-the-counter drugs must be brought in the original container to the nurse during registration. PLEASE DO NOT SEND EXPIRED MEDICATION.


Release Forms

I authorize Calvary Church or any representatives of Calvary Church and/or Illinois District Council of the Assemblies of God (A/G) or any of A/G’s representatives to publish photos of the minor child listed above for use on websites and any other promotional or advertising material created by or for Calvary Church or A/G. I acknowledge that participation on the website and in other promotional or advertising materials produced by Calvary Church or A/G confers no rights of ownership whatsoever and am aware I am not entitled to any compensation. Since anyone can download an image from the Internet or make copies from printed materials, I agree that Calvary Church and A/G is not responsible for unauthorized use of the images. I release the Calvary Church and A/G, their representatives and their employees from liability for any claims by me or any third party in connection with the minor child listed below. I release Calvary Church and A/G from any expectation of confidentiality for the minor child, and attest that I am the parent or legal guardian of the listed child above.

I give permission for my child to ride the Calvary Church bus to and from Lake Williamson Camp Grounds, Carlinville IL. Calvary Youth and Calvary Church are not responsible for injury, loss, damage, or stolen property. I will drop-off my child of by 9:00am on Monday, July 18 at the Jefferson Street Campus and pick him/her up by 12:30pm on Friday, July 22 at the Jefferson Street Campus. I understand that Calvary Church and its representatives have my child’s best interest in mind.

I do hereby state that I have legal custody of this child, a minor, who resides with me. While this minor is a registered camper at any Illinois Assemblies of God summer camp, I hereby authorize Calvary Church, any director, counselor, nurse, dean, lifeguard, or other responsible person of said Camp to consent to any x-ray, examination, anesthetic, medical or surgical treatment, and hospital care, to be rendered to this minor under the general or special supervision and on the advice of any physician or surgeon licensed to practice in the United States, when such medical or surgical treatment is necessary. I also give permission for my child to receive over-the-counter medication from the camp nurse if necessary.

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