Youth Camp 2026 Sign-Up

This camp is for students entering 7th grade (13 years old) through 12th grade (18 years old).

When selecting a grade below, please choose the last grade your student completed.

Current Grade

t-shirt Size

Parent/Legal Guardian Information

This address will receive a confirmation email

Emergency Contact Information

First and Last Name

Student Medical Information

Accident Coverage

I understand that if my student is injured in an accident at camp, my family’s health insurance will be billed first. I also understand that Foursquare’s accident insurance may cover up to $50,000 in additional medical expenses, but it does not cover sickness. For questions, I may contact ICFG Insurance at (213) 989-4400.

Please acknowledge

I understand

Why are we asking for so much medical information?

We know the questions below may feel detailed, but the more information you provide, the better care we can give your student in the event of an accident or emergency. Having complete information helps our staff share what medical professionals need to provide the safest and most effective care.

Do you have insurance?

Insurance ID/Policy Number

Is there any condition we need to be aware of that is currently under a physician's care?

yes no

Is there any chronic or recurring illness(including behavioral) we should know about?

Has there been any operation or serious injury we should be aware of?

Has there been any recent loss of consciousness, convulsions, or a concussion?

Are there any activities to be avoided?

Are there any allergies or dietary restrictions we should know about?

Are there any special needs we should be aware of?

ALL MEDICATIONS MUST BE IN THE CONTAINER LABELED BY THE PHARMACY AND TURNED INTO THE CAMP NURSE. MEDICATION CANNOT BE KEPT IN CABINS.

*Exceptions can be made for asthma and emergency allergic reaction medication.

Does the student require any medication or treatment during camp?

Check the box next to any medical conditions experienced (past or present):

asthma bleeding/clotting disorder convulsions in the last 60 days diabetes epilepsy frequent ear infections heart defect/disease hypertension sickle cell chicken pox measles german measles mumps Hep A Hep B Hep C mononucleosis

Check any immunizations the student has received:

DTaP Tdap MMR Polio Hepatitis B Varicella (chicken pox) Hib The student has not been immunized for personal, religious, or medical reasons. other

Please list the dates of immunizations below:

Parental/Gaurdian Consent

An electronic signature is required to complete this registration. Please provide the information below and instructions will be sent via email to complete the required signatures.

Name of Parent/Guardian

Email of Parent/Guardian

This address will receive a confirmation email

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Youth Camp 2026 Sign-Up

Description

Please Fix the Following