NCYC 2025

First Name of Person attending NCYC: REQUIRED Please fill out this field. Please enter valid data.

Last Name of Person Attending NCYC REQUIRED Please fill out this field. Please enter valid data.

Church Parish REQUIRED Please fill out this field. Please enter valid data.

Grade (current one) REQUIRED Freshman Sophomore Junior Senior Adult Chaperone Please fill out this field.

Gender REQUIRED Male Female Please fill out this field.

Best Email for Person attending NCYC REQUIRED Please fill out this field. Please enter an email address.

T-Shirt Sizes REQUIRED Adult S Adult M Adult L Adult XL Adult 2XL Adult 3XL Adult 4XL Please fill out this field.

Parent Information (if teen) or Emergency Contact (if Adult registering)

First Name REQUIRED Please fill out this field. Please enter valid data.
Last Name REQUIRED Please fill out this field. Please enter valid data.
Relationship to Student (Mother, Father, Grandparent) REQUIRED Please fill out this field. Please enter valid data.
Cell Phone Number REQUIRED Please fill out this field. Please enter valid data.
2nd Phone Number Please enter valid data.
Parent's Email REQUIRED Please fill out this field. Please enter an email address.

Medical Insurance Information

Family Health Plan Carrier REQUIRED Please fill out this field. Please enter valid data.
Insurance Policy Number REQUIRED Please fill out this field. Please enter valid data.
Doctor Name REQUIRED Please fill out this field. Please enter valid data.
Doctor Phone Number REQUIRED Please fill out this field. Please enter valid data.
MEDICAL: I hereby warrant that to the best of my knowledge, my child is in good health and I assume all responsibility for the health of my child. In the event of an emergency I hereby give my permission to be transported to a hospital for emergency or surgical treatment. I wish to be advised prior to any further treatment by the hospital or doctor.

**Note: All medications will be turned in at registration and distributed by our Med Staff.
I have read the above Medical Release statement and agree to it: REQUIRED I agree Please fill out this field.

Camp Karol