Shopping CartYour Cart is EmptyQuantity: RemoveSubtotalTaxesShippingTotalThere was an error with PayPalClick here to try againThank you for your business!You should be receiving an order confirmation from Paypal shortly.Exit Shopping CartToggle NavigationHOMEABOUT USAYC 2021LIFETRAKSCONTACT USHOMEABOUT USAYC 2021LIFETRAKSCONTACT US Appalachian Youth Camp ~ Camper Registration$175 per personYouth 12-20 (must be 12 before Oct 1, 2019) First Name*Middle Name*Last Name*DOB (MM/DD/YYYY)*Email Address*Street Address*City*State*Zip*Mobile Phone*Home PhoneHave You Attended AYC Before?*YesNoChurch*Church City & State*Emergency Contact*Relationship*Emergency Cell Phone*Do you have any food or medication allergies?*YesNoIf yes, please explainDo you have any medical, emotional, behavioral, or physical conditions?*YesNoIf yes, please explainInsurance Company NamePolicy NumberSunday Night Arrival (Sunday night arrivals require pre-approval and will result in additional charges.)YesDo you plan to stay in a dorm or cabin? (Cabin lodging will incur additional fees)*DormCabinParent/Guardian Attestation: I attest that I am either an adult at least 18 years of age and I am registering for myself, or I am the parent or legal guardian of the minor child for whom I am registering.*YesConsent for Medical Treatment: I give my consent to any x-ray examination, anesthetic, medical or surgical diagnosis or treatment or hospital care for either myself or minor child which is deemed advisable by and is rendered under the general or specific supervision of any licensed medical provider. It is understood that this authorization is given in advance of any specific diagnosis or medical care being required, but it is given to provide authority and power to Live God Ministries, Inc. personnel to give consent to any and all such diagnosis, treatment or medical care which the medical provider deems advisable. I understand that I will be responsible for all costs associated with such medical treatment. I also give permission for the camp nurse to dispense Tylenol (acetaminophen) or Ibuprofin if requested by my minor child.*YesConsent for Photos and Videos: I give Live God Loud Ministries, Inc. permission to use photographs and videos of myself or my minor children in the use of the ministry's promotional materials including ministry websites and social media accounts. I understand that I can revoke this permission at any time by contacting Live God Loud Ministries, Inc. in writing.*YesDigital Signature*Today's Date (MM/DD/YYYY)*Click the "Send Message" button to submit your registration.This site uses Google reCAPTCHA technology to fight spam. Your use of reCAPTCHA is subject to Google's Privacy Policy and Terms of Service. SEND MESSAGEThank you for your registration. Your form has been received.AYC Camper Registration$175.00$175.00Add to cart / PreviousNextPausePlayClose