YFT-Youth For Tomorrow Inc

PO BOX 271 Uniondale, NY 11553

2026 Youth Summer Camp

PROGRAM LOCATION

81 Maple Ave Hempstead NY 11550

PARENT/GUARDIAN MUST COMPLETE THIS SECTION
BEFORE APPLICATION WILL BE ACCEPTED!

*Parent/ Guardian’s NameEnter your name

*Parent/Guardian’s Phone NumberEnter your phone number

*Parent/Guardian’s Email AddressEnter your email address

1). I hereby give permission for my child to participate in all activities of the SHBC Summer Camp, and waive all claims to injury or loss of property arising out of participation in said camp with the leaders of this camp, other participants, and the Church.Parent/Guardian Initial Below:

2) I understand that the Camp Insurance Policy provides secondary coverage, and I provide primary coverage for my child. I accept financial responsibility for medical costs beyond limits of camp policy stated here: Medical & Hospital $2500 and Dental $300; eyeglasses are not covered if damaged/lost. All claims must be filed within the year of accidentParent/Guardian Initial Below:.

3) If I cannot be reached in an emergency situation, you have my permission for qualified medical professionals to treat my child. Parent/Guardian Initial Below:

*Name of Insurance Company

*Insurance Policy Number

Date SignedChoose the date from the calendar

*Emergency Contact Please Provide An Emergency Contact

*Emergency Contact’s Phone NumberEnter Number of Emergency Contact

Payment Section

*Did you make a deposit or full paymentchoose one

Deposit

Full Payment

Payments made viachoose one

Check

CashApp

Zelle

If paying by checkChoose the date the check was/will be mailed

If paid by CashApp or Zelle

Proof of PaymentUpload A ScreenShot of Payment

Youth Camper’s Application

*First Name

*Last Name

*Gender

Male

Female

*AGE

*Date of Birth

*Phone Number

*Date of Last Tetanus Shot

*Email

*Mailing Addressenter full mailing address

List all pre-existing medical conditions and prescribed medications(All meds must be in pharmacy labeled container)

Allergies & Reactions

REGISTRATION INFO

Payment Section

Youth Camper’s Application

MOBILE PAYMENTS

CHECK OR MONEY ORDER