AYC CAMPER REGISTRATION 2020

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Appalachian Youth Camp ~ Camper Registration

$15 per person

Youth 11-20

First Name*

Middle Name*

Last Name*

DOB (MM/DD/YYYY)*

Email Address*

Street Address*

City*

State*

Zip*

Mobile Phone*

Have You Attended AYC Before?*

YesNo

Church*

Church City & State*

Parent/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.*

Yes

Consent 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.*

Yes

Digital Signature*

Today's Date (MM/DD/YYYY)*

Click the "Send Message" button to submit your registration.

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My ProAYC Camper Registrationduct

$15.00