Come enjoy a faith-filled Quinipet tradition,
and stay for the sunsets, private beaches and
a quality family time vacation!

PLEASE NOTE! Any campers under the age of 18 attending Family Camp WITHOUT A PARENT/LEGAL GUARDIAN (i.e. Grandparent, Aunt/Uncle, family friend, etc.), must have our Camper Medical Form completed by their licensed health care provider and submitted prior to attending Family Camp. Our Nurse will not be able to treat any minor that does not have a signed Camper Medical Form if attending Family Camp with an adult who is not their parent/legal guardian.

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* 2. Primary Camper Information (Your Information)
*Primary Camper must be 18 years of age or older.

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* 3. Camper Information (Please list each additional camper)

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* 4. Emergency Contact Information
*Please inform this person of their responsibilities as Emergency Contact.

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* 5. PAYMENT METHOD (50% Deposit due upon Registration)
Final Payment due by June 1st
Ages 12+: $450/week  Ages 4-11: $300/week Ages 0-3: No Cost

*Financial Assistance is available to those who qualify.  NYAC Camp Scholarship Applications for Family Camp are due April 5, 2019.
TERMS & CONDITIONS
I hereby enroll myself and/or my family members listed above with The New York Conference of The United Methodist Church Family Camp for the 2019 session and agree to the following terms and conditions:
  • All information supplied in this camper registration form is correct.
  • I agree to complete and return any additional registration material in a timely manner after registration is confirmed. All forms and final payment are due June 1, 2019.
  • I recognize the risks associated with camp and the camp program, and do not hold The New York Conference of The United Methodist Church responsible or legally liable unless losses and/or injury results directly from the negligent or willful act of staff acting within the scope of their responsibilities.
  • I give permission and consent for myself and my campers to participate in all activities associated with Family Camp unless a restriction or limitation is described on their Camper Health Form. Camp activities may include, but are not limited to, swimming, camp fire building, and climbing.
  • I give permission and consent for myself and my campers to allow photographs and videos to be taken during Family Camp session activities. I further give permission and consent that any such photographs and videos may be published and used by the New York Conference of The United Methodist Church and its agents, to illustrate and promote the camp experience and/or camp programs.
  • The New York Conference of The United Methodist Church camps may transport my campers in camp vehicles to and from an approved off-camp activity or trip or in the case of an emergency.
  • I give permission to release Camper Health Forms to health officials in emergency situations and in case of illness and injury. If I become incapacitated, and my emergency contacts cannot be reached, I give permission to the physician selected by the camp to order x-rays, routine tests, and treatment related to the health of my campers in emergency situations. If I become incapacitated, and my emergency contacts cannot be reached, I give my permission to the physician to hospitalize, secure proper treatment for, and order injection, anesthesia, or surgery for myself and my campers.
  • I understand the information on this form will be shared on a need-to-know basis with camp staff. 
  • I understand that I am financially responsible for all medical expenses, including prescriptions, incurred on behalf of myself and my campers.

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* 6. Please indicate below:

You will receive a confirmation of your reservation and invoice from our office following the submission of this form.

We'll see you soon!

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