Winter Camp 2026

Camps and Trips Registration
Student Information
Student Name *

First NameLast Name
Student Phone Number
Please enter a valid phone number.
Age*
School Grade*

6th7th8th9th10th11th12th
Gender*

MaleFemale
Tee Shirt Size*

XSSMLXLXXL
Student Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Information
Name*

First NameLast Name
Parent/Guardian Phone Number*
Parent/Guardian E-mail*
example@example.com
Primary Emergency Contact's Name*

First NameLast Name
Relationship
Primary Emergency Contact's Phone Number*
Primary Emergency Contact's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Secondary Emergency Contact's Name

First NameLast Name
Relationship
Secondary Emergency Contact's Phone Number
Student Medical Information
Does your student have any medical conditions to which YFC staff should be aware? If yes, please describe.
Allergies: Select those that apply and specify the nature of the allergic reaction*

NoneAnimalsEnvironmentalMedicationFoodInsectsLatexOther
Specify the nature of the allergic reaction(s) selected above*
If none, type "none"
Non-Prescription Medications: The following non-prescription medications may be used on an as needed basis to manage illness and injury. Please indicate below which medications the participant may NOT receive. These non-prescription medications will be administered by YFC staff according to manufacturer's labeled dosages unless a written statement (prescription) from participant's health-care provider authorizes a different dosage.

All non-prescription medications need to be turned in to the camp nurse upon arrival. The nurse will administer medication as needed, if needed. Medications will be returned upon departure.
Mark the following medications your camper should NOT have

Acetaminophen (i.e. Tylenol)Aloe Vera GelAntacid (i.e. Tums)Antiseptic Wipes Benzalkonium Chloride)Bacitracin/Triple Antibiotic OintmentCalamine LotionDiphenhydramine Oral Tablet (i.e. Benadryl)Cough DropsHydrocortisone 1%/Anti-Itch Cream (i.e. Benadryl Cream)Ibuprofen (i.e. Advil)Loperamide HCI (i.e. Imodium ADLoratadine (i.e. Claritin)Menstrual Relief (i.e. Midol)Sunscreen LotionVoSol Ear Drops (i.e. Swim Ear)
Medication Administration Instructions: "If medicine is present during YFC activiteis, that medicine must have written instructions present with it during the activity from a doctor, parent, or legal guardian."

Any medication, prescription or over-the-counter, brought to a YFC activity must have written medical instructions and dosage information from a physician, parent or legal guardian. All medications must be in the original container when issued.

Please describe all the details of dosing and administering prescription meds, nonprescition meds, and/or nutritional supplements the particiapant is bringing with them, as well as any drug interactions that you are aware of with these medication prescriptions.
Medication #1 Name
Medication #1 Time of Day Given
Is Medication #1 Given with Food?

YesNo
Medication #2 Name
Medication #2 Time of Day Given
Is Medication #2 Given with Food?

YesNo
Medication #3 Name
Medication #3 Time of Day Given
Is Medication #3 Given with Food?

YesNo
Medication #4 Name
Medication #4 Time of Day Given
Is Medication #4 Given with Food?

YesNo
Medication #5 Name
Medication #5 Time of Day Given
Is Medication #5 Given with Food?

YesNo
Diet Modification Information
If your student has a special diet, please read through and complete the following section.
Please note: campers with personal lifestyle choices (ex: vegetarian or vegan) are responsible for their own meal supplements. Lake Geneva does not cook with peanuts, peanut oil, etc. However, foods shipped to camp may be made in a facility with nuts, so cross contamination may happen. Lake Geneva cannot provide a peanut free camp, and their Snack Shack does contain items with allergens. Lake Geneva cannot guarantee a 100% allergy free environment.
Please indicate the specific type of diet modification needed, foods to be omitted orsubstituted, and/or medical reason for diet modification (diets not prescribed by aphysician are the individual's responsibility)
I herby request that my child is to receive a modified diet as prescribed by his/her
physician
Signature of Parent/Guardian

Clear
Please read our Consent and Release of Liability and check the box below

PAY ONLINE BELOW OR SEND PAYMENT to PO Box 105, Jamestown, ND 58402. You may also drop off at YFC office. To be a good steward of our scholarship money, we ask that you pay what you can so we can help more kids go to camp. If a full scholarship is needed or you wish to pay with other means, please skip this payment section and contact the YFC office at 701-252-5501.

I will pay full amount online

$170.00

I can pay half online but request the rest in scholarship

$85.00

I can pay $50.00 online but request the rest in scholarship

$50.00

Total

$0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Signature of Parent/Legal Guardian *

Clear
Should be Empty:

Camps and Trips Registration

Student Information

Parent/Guardian Information

Student Medical Information