RevTabYouthCamp Registration Form

RevTab Youth Camp

July 24 - 28, 2023
Registration Details: Camper Registration includes a camp t-shirt and a $10 canteen card
- Camper Early Registration : $200 (ends June 18th)
- Camper Late Registration: $250
- CIT Early Registration: $150 (ends June 18th)
- CIT Late Registration: $200
- Payment method: cash, check, credit card, apple pay, google pay accepted. Please make the check payable to RevTab Youth Camp and write your child's full name on the memo line.
All Staff must submit current (within 5 years) background clearances to revtabyouthcamp@gmail.com.

Contact: For more information, please contact Darlene Johnson at revtabyouthcamp@gmail.com or 570-538-2000.
CIT (counselor-in-training) Program: designed to help train, prepare and transition experienced campers into future counselors and/or staff.

1. Must be entering senior year of high school or have just graduated. (If CIT is 17, a parent must sign this application)

2. Must have at least one year's experience as a camper at RevTab Youth Camp.

3. Must obtain their Pastor's recommendation.

4. Be exemplary in attitude/behavior always. CIT's will be responsible to Deans & Senior counselors

5. CIT will be assigned toa Senior counselor or staff, serving as an aide in fulfilling assigned duties. This responsibility will be daily, but limited to certain times. The remainder of the time, CIT's will function as a typical camper.

PARENT/GUARDIAN INFORMATION
Parent/Guardian Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState

Postal Code
Home Phone Number

Area CodePhone Number
Cell Phone Number*

Area CodePhone Number
Parent Email
example@example.com
Do you have legal custody of the child who is being registered?*

YesNoN/A
Do you attend church regularly*

YesNo
Home Church (if applicable)
Pastor's Name

First NameLast Name
Pastor's Phone Number

Area CodePhone Number
Emergency Contact (other than the parent above)

In the case that we are unable to reach you in an emergency, please provide the name and number of someone we can contact (other than the parent above).
Emergency Contact Name*

First NameLast Name
Emergency Contact Number*

Area CodePhone Number
Relationship to Applicant*