Registration

All Churches are asked to pre-register by May 1st, 2025. (There will be a $5.00 late registration fee per person that registers after May 1st, 2025.)

YOUTH CAMP PARTICPANT APPLICATION FORM

Eastern Indiana Pentecostal Fellowship, Inc. is the sponsoring organization that is allowing at the campground at or near 5650 W County Road 250 N, Connersville, IN 47331. Activities will be provided during the camp including but not limited to Bounce Houses, Basketball, Volley Ball, Soft Ball and ATV rides (ATV rides are for all participants 12 years of age and over during the dates of May 27, 2025 – May 30, 2025. These ATV’s are personally owned by the drivers that are allowing the Participants to ride in their ATV on the property owned by Eastern Indiana Pentecostal Fellowship, Inc.)

The cost for each Participant is $80.

Each counselor and adult 18 years and older (and staying on the grounds) is required to complete a participant agreement, pay registration fee of $85 along with a $9 additional charge for background check and allow a background check to be completed.

(There will be a $5.00 late registration fee per person that registers after May 1st, 2025.)

Name of Church that Participant attends:(Required)

Name of Participant:(Required)

First Last

I am a .... (must choose one)(Required)

Camper (my cost is $80)

Counsellor (my cost is $85, includes background check)

An Adult staying on the grounds (my cost is $85, includes background check)

Include Drink Package for Participant (Drink Package is unlimited soft drink package for the entire week of camp that also includes a souvenir cup $30):(Required)

YES

Name of Parent/Guardian (if Participant is a Minor):

First Last

Date of Birth of Participant:(Required)

Gender of Participant:(Required)

Male

Female

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone(Required)

Email(Required)

Name of Emergency Contact:(Required)

First Last

Phone of Emergency Contact:(Required)

Is E. I. P. F., Inc. authorized to approve Medical Treatment?(Required)

YES

Is Participant covered by personal/family medical insurance?(Required)

YES

If yes, Name of Insurer:

If yes, Policy Number or Group Number:

Consent(Required)

I have read the Rules and Regulations and agree to them

Regulations

All persons staying on the campground and all those attending day services and/or activities must be registered.
No one may leave the campground without permission.
All campers, must attend all services.
No radios, tape players, CD players, MP3 Players, Cell Phones, Tablets, Cameras or other recording devises, etc. allowed in the dorms. (Camper’s cell phones will only be allowed during Lunch each day and must be returned to counselors for the remainder of the day.)
No Smoking
No candles, incense, or other open flames allowed in dorms.
Boys are not allowed in or around girls’ dorm and girls are not allowed in or around boys’ dorm.
Non-married Couples are to remain in open lighted areas
Non-married Couples are to maintain a distance of 6 inches or at all times.
Campers may only engage in approved camp activities.
Children under the age of 12 are not allowed in the dorms.

Dress Code

In an effort to maintain the Biblical principals of modesty:

Boys pants must be long and a modest shirt at all times outside of the dorm.

Girls skirts and dresses should be well below the knee at all times. All tops must not have a low cut neckline or a high cut waistline.

No shorts, sleeveless shirts, culottes, tight fitting clothing, bathing suits, or clothing with offensive or suggestive writing or pictures are not to be worn by boys or girls.

No earrings, necklaces or other forms of jewelry are to be worn by boys or girls.

Responsibilities

All rules must be obeyed.
Each person must keep clean his or her own area in the dorm and tabernacle.
Each person must accept and complete assigned duties.
Campers must be in bed with lights out at specified time.
Campers must remain in the tabernacle until dismissed from the pulpit.

Counselors
Each Church is expected to provide their own counselors for any Boys and Girls that are sent by the Church.

Consent (MUST READ IN FULL)(Required)

I agree to the Participation Agreement

Participation Agreement I acknowledge that participation in the activity described above involves risk to the participant (and to the participant’s parents or guardians, if the participant is a minor), and may result in various types of injury including, but not limited to, the following: sickness, exposure to infectious/communicable disease, bodily injury, death, emotional injury, personal injury, property damage, and financial damage. In consideration for the opportunity to participate in the activity described above (the “activity”), the participant (or parent/guardian if the participant is a minor) acknowledges and accepts the risks of injury associated with participation in and transportation to and from the activity. The participant (or parent/guardian) accepts personal financial responsibility for any injury or other loss sustained during the activity or during transportation to and from the activity, as well as for any medical treatment rendered to the participant that is authorized by the sponsor or its agents, employees, volunteers, or any other representatives (collectively referred to as the “activity sponsor”). Further, the participant (or parent/guardian) releases and promises to indemnify, defend, and hold harmless the activity sponsor for any injury arising directly or indirectly out of the described activity or transportation to and from the activity, whether such injury arises out of the negligence of the activity sponsor, the participant, or otherwise. If a dispute over this agreement or any claim for damages arises, the participant (or parent/guardian) agrees to resolve the matter through a mutually acceptable alternative dispute resolution process. If the participant (or parent/guardian) and the activity sponsor cannot agree upon such a process, the dispute will be submitted to a three-member arbitration panel for resolution in accordance with the rules of the American Arbitration Association.

Participant's Signature(Required)

Date(Required)

Signature of Parent (if Participant is a Minor):

Date

CAPTCHA

Consent(Required)

I understand that payment must be submitted along with this Application (you will be redirected to the payment page after you click SUBMIT)

If submitting payment for more than one applicant, refresh the Youth Camp Activity Participation Agreement Form and complete for next Applicant

This field is for validation purposes and should be left unchanged.

ADD ANOTHER PARTICIPANT

For more Participant Applications, click on the menu and select YOUTH CAMP / REGISTRATION again. Complete next form and repeat as needed.

PAY VIA TITHE.LY

Include the cost for all participants. Please email Bro. Joshua Staggs joshuastaggs123@yahoo.com with the name of the Church, the names of the Participants paid for, and the name you used for the ONLINE PAYMENT