Register—Session 5 – Camp Youth Incorporated

Register for Session 5: July 12–17, 2026

Camper Type

Session

Camper First Name

/ Date Phone

Camper Last Name

Camper Date of Birth

Cabinmate Request

Put first and last name. Must be within the same age range as registering camper.

Parent / Guardian Name

First

Last

Parent / Guardian Email

Parent / Guardian Phone

Home Address

Address Line 1

Address Line 2

City

State

Zip Code

Emergency Contact Name

First

Last

Emergency Contact Phone

Emergency Contact Relationship

Example: Parent, Aunt, Grandparent, Neighbor

List of those authorized to pickup camper

Authorized Pick-up Name

First

Last

Authorized Pick-up Phone

Relation to Camper

Example: Parent, Aunt, Grandparent, Neighbor

Additional Comments