New Heights Youth Camp Registration
Type of Registration

"Youth Registration" is for all youth, coming individually or with a group.

"Adult Registration" is for all adults who will be staying for the camp.

"Group registration" is for youth leaders who need to communicate group details to us. Youth should not use this registration.

Important Notice for Groups

Complete this group registration so we know that you are coming together. We will use this information to know who to contact in case of any changes, and to assist us in assigning teams and housing assignments. Please understand that we must receive the individual registration for each person attending also. Please contact each member of your group and ask them to register themselves ASAP. If you are using the brochure/paper forms instead of the web form, you may email copies of the paper forms to us at youthcamp@kmbc.edu and we will hold your slot. Be sure to bring the paper forms with you when you arrive for camp.

Are you attending New Heights with your group?
Name
Name
First Name
Middle Name
Last Name
Gender
Enter Email
Address
Address
City
State/Province
Zip/Postal
Group Leader
Group Leader
First Name
Last Name
If unsure, provide an estimate.
If unsure, provide an estimate.

Note: Background checks are required for all adults working with youth. If you have a background check already completed, please send that to us.

Notes: Background checks are required for all adults working with youth. If you or an adult in your group has a background check already completed, please send that to us.

Several activities at New Heights Youth Camp take place off-campus. Groups that bring their own vehicles may be asked to assist with transporting their youth to these off-site activity locations.

The following information is needed so that KMBC can run a background check. Sensitive information will not be shared with unnecessary parties.
Do not include the dashes. If you prefer, you may call us to give us this number: 606-332-0130
I release KMBC to perform a background check on me. I understand that this background check will be used to inform churches and camps of my fitness to serve.
I understand the information supplied by me must be truthful and falsification with an intent to mislead may result in my prosecution under KRS 523.100. I have provided the basic information necessary to qualify for record processing.
Parent/Guardian
Parent/Guardian
First Name
Last Name
Is parent/guardian emergency contact?
Emergency Contact Name
Emergency Contact Name
First Name
Last Name

Medical Questionnaire

I, the undersigned parent/legal guardian, authorize camp staff to administer the following non-prescription (over-the-counter) medications to my child as needed for common, non-emergency ailments (e.g., headaches, minor pain, fever, allergies, upset stomach), in accordance with standard dosage instructions and under the oversight of designated camp personnel.
I, the undersigned parent/legal guardian authorize the following non-prescription medication to be administered to my child:
Will your child require any prescription medication to be administered during camp?

All medication must be provided to camp staff at registration. All medications must be in original and updated containers.

Prescription Medication

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Parent/Legal Guardian Consent

I, the undersigned parent/guardian, hereby consent to my child participating in the New Heights Youth Camp, an event sponsored by Kentucky Mountain Bible College, meeting multiple weeks in the summer. I consent to allow my child to be photographed or recorded during the event for public relations by KMBC and it's employees. I certify that my child is able to participate in the camp activities as listed in the brochure and otherwise. I understand that NHYC is an active camp and may not be suitable for individuals with physical limitations and or emotional/behavioral special needs. I understand that if my child falls into this category that they must be accompanied by a parent or chaperone. If my child has medical conditions which may be relevant to a physician in the event of an emergency, I have listed them. In the event of an emergency, I may be reached at the telephone numbers listed above. If I cannot be contacted, I hereby authorize Kentucky Mountain Bible College, its agents or employees to obtain such medical treatment as may be necessary in their judgment to ensure health, safety and well-being of my child. I understand and hereby agree to assume all risks which may be encountered on said activity, including activities preliminary and subsequent there to. I hereby agree to hold Kentucky Mountain Bible College, their agents and employees harmless from any and all liability, actions, causes of actions, claims, expenses, and damages on account of injury to my child, property even injury resulting in death, which I now have or which may arise in the future in connection with the activity or participation in any other associated activities. I expressly agree that this release, waiver and indemnity agreement is intended to be broad and inclusive as permitted by law of the State of Kentucky and that if any portion thereof is held invalid; it is agreed the balance shall, notwithstanding, continue in full legal force and effect. This release contains the entire agreement between the parties hereto and the terms of this release are contractual and a mere recital. I will disclose and update any changes that may occur to this release before the date of the event. I further state that I have carefully read the foregoing release and know the contents thereof and I sign this release as my own free act. This is a legally binding agreement which I have read and understood.
I, the undersigned parent/legal guardian, have read the above statement and agree.
I understand that participation in youth camp activities involves inherent risks, including but not limited to potential exposure to COVID-19, and I accept full responsibility for these risks and release Kentucky Mountain Bible College, its employees, and affiliated parties from liability. In case of an emergency, I hereby authorize Kentucky Mountain Bible College, its agents or employees to obtain such medical treatment as may be necessary in their judgment to ensure health, safety and well-being. I understand and hereby agree to assume all risks which may be encountered on said activity, including activities preliminary and subsequent there to. I hereby agree to hold Kentucky Mountain Bible College, their agents and employees harmless from any and all liability, actions, causes of actions, claims, expenses, and damages on account of injury to me or property, even injury resulting in death, which I now have or which may arise in the future in connection with the activity or participation in any other associated activities. I understand the risks involved with COVID-19 exposure and otherwise with group camp activities, and incidents related to COVID-19 are expressly included as part of this waiver. I expressly agree that this release, waiver and indemnity agreement is intended to be broad and inclusive as permitted by law of the State of Kentucky and that if any portion thereof is held invalid; it is agreed the balance shall, notwithstanding, continue in full legal force and effect. This release contains the entire agreement between the parties hereto and the terms of this release are contractual and a mere recital. I will disclose and update any changes that may occur to this release before the date of the event. I further state that I have carefully read the foregoing release and know the contents thereof and I sign this release as my own free act. This is a legally binding agreement which I have read and understood.
I, the undersigned, have read the above statement and agree.
Are you coming with a group?
Which camp will you (or your group) be attending?