Clone of RevTab Youth Camp Registration Form 2026
  • Staff Registration Details

    All Staff must submit current (within 5 years) background clearances to revtabyouthcamp@gmail.com. 

    Payment method: Cash, Check, Credit Card, Apple Pay, and Google Pay accepted. Please make the check payable to RevTab Youth Camp and write your full name on the memo line.

    Contact: For more information, please contact Donna Wenrick at revtabyouthcamp@gmail.com or leave a message at 570-538-2000, Ext. 100.


    PA State Police Criminal History Background Check:

    https://www.psp.pa.gov/Pages/Criminal-History-Background-Check.aspx

    PA DHS Child Abuse History Clearance:

    https://www.dhs.pa.gov/KeepKidsSafe/Clearances/Pages/PA-Child-Abuse-History-Clearance.aspx

    FBI Clearance & Fingerprinting (Required for volunteers who have lived in PA for less than 10 years.):

    https://www.dhs.pa.gov/KeepKidsSafe/Clearances/Pages/FBI-Fingerprinting.aspx

    FBI Clearance Affidavit (For those living in PA for the last consecutive 10 years.):

    https://www.gettysburg.edu/offices/human-resources/pdfs/2019/AffidavitVolunteerServicePAResidentsfor10yearsA4360414.pdf

  • STAFF INFORMATION

    STAFF INFORMATION

  •  / /
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.

  • Emergency Contact

    In case we are unable to reach you in an emergency, please provide the name and number of someone we can contact (other than the parent above).
  • Format: (000) 000-0000.
  • Medical Information

    Medical Information

    Fields with an asterisk(*) are required.
  • Format: (000) 000-0000.
  • PLEASE READ BEFORE SIGNING

    Agreement to Participate

    The proposed activities provided by RevTab Youth Camp require participation in physical exercises which are, by their nature, physically demanding. If there is any doubt about your ability to safely participate in any physical activity at youth camp, please seek and provide authorization from your medical provider. It is solely your responsibility to receive the necessary approval from the appropriate health care providers for your participation in all physical activities. If more information is needed, please contact RevTab Youth Camp, at (570) 538-2000 or email us at revtabyouthcamp@gmail.com.

    Assumption of Risk and Release of Liability

    Activities at RevTab Youth Camp may result in loss or damage to personal property, physical injury, or fatality due to accident. My authorization below indicates that I am healthy (both physically and emotionally) and capable of participating in RevTab Youth Camp.  The person herein described has permission to engage in all prescribed activities unless otherwise noted. I fully authorize the camp’s medical personnel to treat me. I do hereby release Revival Tabernacle, Inc., it's affiliates including RevTab Youth Camp and its employees from any and all liability, including, but not limited to, any negligence of the aforementioned.  I also understand that my participation is entirely voluntary. I take full responsibility to participate or not participate and agree to follow all safety instructions. My e-signature below should be considered the authorization to both the Agreement to Participate and the Assumption of Release and Liability.

  • Powered by Jotform SignClear
  • Staff Registration: No Fee

     

  • prevnext( X )
    USD

    Payment Methods

    creditcard
    After submitting the form, you will be redirected to Apple Pay to complete the payment.
    After submitting the form, you will be redirected to Google Pay to complete the payment.
  • Should be Empty: