"Just Keep Swimming" Heartland Region Youth Camp 2026 Registration

Just Keep Swimming| Youth Camp 2026

Teen Camp and Jr. Camp Registration Form

REGISTRATION INFORMATION:

Teen Camp | June 29th - July 3rd | Ages 13-18
Jr. Camp| July 6th - July 10th | Ages 7-12

1. Early Bird Registration Fee (Ends April 18th):
$185.00 COG Members, $215.00 for Non-COG Members. (Free T-shirt comes with both)

2. Standard Registration Fee (April 18th - June 10th)
$210.00 COG Members, $240.00 Non-COG Members

3. Late Registration Fee (AFTER JUNE 10th):
$235.00 COG Members, $265.00 Non-COG Members

*A Deposit of $25 will be Required to Register*

To Recieve A Free T Shirt, Please Register By June 1st

Statement of Reservation
While no one is rejected to work or attend Church of God Youth Camp on the basis of race, color, or creed, the State Youth Director reserves the right to accept or reject an application for volunteer work at Church of God Youth Camps. After review of said application reveals that the services of the applicant would or would not be in the best interest and success of the camp. An application may be rejected due to the fact that all positions have been filled for selected camp.
Camper Info

Please fill out your child's information
Please Select Your Camp*
Student's Age*
Student's Name*

First NameLast Name
Select One*

MaleFemale
Date of Birth*

MonthDayYear
Date
Upcoming Grade Level*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Father/Guardian Full Name*

First NameLast Name
Mother/Guardian Full Name*

First NameLast Name
Parent/Guardian Phone Number*
Alternative Phone Number*
Parent/Guardian Email Address*
example@example.com

Church Information

Please fill out your church information
Do you currently attend a local Church of God?*
Name of local church you attend*
Pastor's Name*

First NameLast Name
Youth Leader's Name*

First NameLast Name
Youth Leader's Email*
example@example.com

Roommate Preferences

We cannot guarantee your roommate preference, however we will do our best to accommodate requests that are submitted at least 14 days prior to the start of your selected camp.
Room with MY Church?

YesNo
Roommate Preference
Dorm Leader Preference
Camper Agreement
As a camper of the Church of God Youth Camp, I agree to abide by the rules and policies of the camp during my stay at camp. I understand that any deliberate breach of conduct or disregard of camp rules will necessitate disciplinary action, even to the extent of being asked to leave the camp. I agree to conduct myself according to the principles and biblical beliefs of the Church of God during my participation at the camp. Any conduct which violates these principles and beliefs may be grounds for my dismissal from the camp, the transportation and other costs of which will be my responsibility. The camp administration retains full and sole discretion to dismiss me from the camp, for any reason it deems necessary.
Campers Name

First NameLast Name
Camper Signature*

T-Shirt Options

Below, please select your students T-Shirt size
Student T-Shirt Size (Guaranteed Free T-Shirt for Kids Camp if registered by June 1st) *
Please select the correct size for your student.
Pre-Order Camp Video (Digital Download)*
Video will be emailed after camp is concluded.
Email for Digital Download Camp Video if Purchased*
example@example.com

PAYMENTS*

Early Bird Registration Fee (COG Member

$185.00

Early Bird Registration Fee (Non-COG)

$215.00

DEPOSIT ONLYREMAINING BALANCE WILL BE DUE UPON ARRIVAL AT EVENT CHECK-IN

$25.00

Total

$0.00

Credit Card

Payment Page

*Note DEPOSIT DUE upon submission of this form. Canteen cards are available for purchase upon arrival. Please pay in full or secure your spot with a deposit.
Should be Empty:

	Yes	No
Acetaminophen (compared to active ingredient in Tylenol)
Ibuprofen (compared to active ingredient in Advil)
Diphenhydramine HCI (compared to active ingredient in Benadryl)
Guaifenesin (compared to active ingredient in Robitussin or Mucinex)
Bismuth Subsalicylate (compared to active ingredient in Pepto Bismol)
Calcium Carbonate Antacid (compared to active ingredient in Tums)
Hydrocortisone Cream 1% for itching/rash

Just Keep Swimming| Youth Camp 2026

Camper Info

Church Information

Roommate Preferences

Camper Agreement

Medical Information

A parent/guardian must complete this section.

Insurance Information

Parent / Guardian must complete this section

T-Shirt Options

Credit Card

Payment Page