2024 Impact MI Youth Camp Application

Health Form

Emergency Contact

Cost:

$15 non-refundable deposit required for form submission
$130 if form is submitted before June 1 for Elementary and High School Camps, July 1st for Junior High
$150 if form is submitted after June 1 for Elementary and High School Camps, July 1st for Junior High
Fee includes: Lodging, all meals, activities

Fee does not include concession (open in the afternoon and evenings)

Final payment is due upon arrival at the campground
Make Checks payable to: Impact MI PCG; P.O Box 187 Saint Johns, MI 48879

BAPTISM:

At the end of Junior High Camp (Grades 5-8) and High School Camp (Grades 9 & up) we offer baptisms during the Friday morning sessions before departure from camp. If your student decides they feel the call to be baptized, does Impact MI have the consent to proceed with the baptismal? If yes, we will have your student contact you in case you would like to arrive early to be apart of the service.

BY SIGNING MY NAME AND SUBMITTING BELOW:

Parent / guardian gives permission for necessary treatment and emergency treatment in the event of illness / injury with parents not available. Acknowledges and accepts the risk of physical injury associated with participation in the activities of youth camp. Except for gross negligence on the part of the sponsor, the participant (or parent / guardian) accepts personal financial responsibility for any bodily or personal injury sustained during the activities of youth camp. Further, the participant (or parent / guardian) promises to hold harmless Impact MI, PCG, the Michigan District of the Pentecostal Church of God and its representatives for all loss, property damage or injury related to the activities of youth camp. I also allow my child's photo to be used for any promotional materials (social media, printing, etc.) during the week or in the future (any issues legally pertaining to photos, please contact us directly).

COVID-19 Release

The novel Coronavirus, COVID-19, has been declared a world-wide pandemic by the World Health Organization.

By participating in programs, services, and activities of Impact MI, PCG, Michigan District PCG, you agree to the following:

On behalf of yourself and your children, you hereby release, covenant not to sue, discharge, and hold harmless Impact MI, PCG, Michigan District PCG, it's emplloyees, agents, and representatives, of and from all liabilities, claims, actions, damages, costs or expanses of any kind arising out of or relating to your participation in our programs, services, or activities. You understand and agree that this release includes and claims based on the actions, omissions, or negligence of this organization, it's employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after participation in any such programs, service, or activity.