Deaf Extreme Youth Camp Registration 2026 Deaf Extreme Youth Camp 2026 (#21)ΔRegistration & Medical FormComplete the form below then follow the instructions for the payment screen. Fill out one form per camper.First NameLast NameDate of BirthAgeDeaf or Hearing?DeafHearingAddressAddress Line 1Address Line 2CityStateZip CodeName of church the camper is withParent/GuardianName of Parent/GuardianEmailCell PhoneEmergency Contact NameEmergency Contact PhoneSecondary Emergency Contact NameSecondary Emergency Contact PhoneHealth HistoryHealth History (Check all that apply) Asthma Epilepsy ADD/HD Diabetes Heart condition/problems High blood pressureHealth History Continued (check all that apply) Swimmers Ear Heart Disorder Mononucleosis Seizure Frequent Ear InfectionAllergies (Check all that apply) Hay Fever Bee Stings Penicillin Foods OtherIf food allergy, please listIf other allergy, or drug allergy, please listDate of last tetanusDate if boosterDate of DTPActivities to be limited by physician's adviceList current medications and reasonInsurance NameGroup/Policy #Physicians NamePhysician's Phone I or my my child are not covered by insuranceI or my child may have swimmer's ear prevention drops after swimming if necessaryYesNoI or my child may have Tylenol for minor aches and painsYesNoI or my child may have Ibuprofen for minor aches or pains.YesNoPayment OptionsPlease select one: I'll pay online I plan to pay with check/money order when I arrive at campHarvest Deaf Camp 2026 T-ShirtsPre-order your camp shirt to have it ready for you when you arrive at camp! You will pay for your shirt when you check in at the registration table at camp. Deadline to pre-order camp shirts is June 15th.Adult T-Shirt SizeYouth T-Shirt SizeRegister
