Youth Application

Camper's Contact Details

Camper's Name(Required)

First Last

Camper's Email(Required)

Camper's Cell(Required)

Birthday(Required)

Age(Required)

Gender(Required)

School(Required)

Grade (2025-2026)(Required)

T-Shirt Size(Required)

Church Membership(Required)

How many years have you participated in Sea City Work Camp?(Required)

First Choice of Work Site(Required)

Painting

Roofing

Note: All work assignments will be at the discretion of the Camp Director.

Provide a Service Hour Certificate(Required)

Yes

Parent's or Guardian's Information

Parent's Name(Required)

Parent's Email(Required)

Parent's Cell Phone(Required)

Alternate / Other Cell Phone

Address(Required)

Street Address City State / Province / Region ZIP / Postal Code

Permissions

RELEASE PHONE NUMBER FOR CAMP ROSTER(Required)

YES

RELEASE ADDRESS FOR CAMP ROSTER (INCLUDES EMAIL ADDRESS)(Required)

YES

RELEASE ANY/ALL PHOTOS TAKEN DURING CAMP FOR FUTURE PUBLICITY, GRANT REPORTS, SOCIAL MEDIA(Required)

YES

Release of Liability

I understand that the Sea City Work Camp, a housing rehabilitation project, is physically demanding. I recognize the risk of injury by participating in this event. I understand that I must assume the risk of injury and any related financial responsibility that could result from participating in these activities. I release the Corpus Christi District Office of the United Methodist Church, Sea City Work Camp, the participating churches, staff members, directors, and volunteers from all liability for any injury occurring while participating in any activities held during the Sea City Work Camp.

I have completed this application with full honesty, and I am liable to provide any information to the Camp Director in writing if there should be any changes to the camper’s application by the time camp begins. I have read and agree to abide by the Sea City Work Camp Covenant as stated on the next page. I have read and understand the Release of Liability. I give my permission for my child to participate in the Sea City Work Camp, a housing rehabilitation project in Corpus Christi, Texas. In the judgment of any representative of the Sea City Work Camp, if the above-named camper should need immediate care and treatment as a result of any injury or sickness, I do hereby request, authorize, and consent to such care and treatment as may be given to said camper by any physician, hospital, or Sea City Work Camp representative.

Participant Signature(Required)

Your Name
Your Name
Your Name

Parent or Guardian Signature(Required)

Your Name
Your Name
Your Name

Medical Information

1. Is there evidence or history of Heart Problems or High Blood Pressure chronic infection of nose, throat, ears, sinus, and lungs? If so, what?(Required)

2. Have you had an appendectomy?(Required)

3. Has there been recent exposure to a contagious disease? If so, what?(Required)

5. Are you subject to:

High blood pressure

Fainting

Convulsions

Sleep walking

Asthma

Hay fever

Overheating

6. List inoculations that are still active

Tetanus

Polio

Others

Date of Last Tetanus(Required)

List other inoculations still active

7. List all allergies

Penicillin

Sulfa

Insect stings

Drugs

List other allergies

Any food allergies (list)?

8. Are you on routine medication?(Required)

Yes

If yes, name drug, dosage, and instructions

9. List any diet restrictions

10. Are there any restrictions or special needs be observed during work camp? (If so, explain)

11. Family Physician(Required)

Office Phone(Required)

Insurance Company(Required)

Insurance Policy Number(Required)

Insurance in the name of(Required)

Relationship to Camper(Required)

Helpful Comments Concerning Camper

Emergency Contact

Name(Required)

Relationship(Required)

Phone (work)(Required)

Phone (cell)(Required)

Phone (home)

I give my permission for my daughter/son to participate in the Sea City Work Camp, a housing rehabilitation project in Corpus Christi, Texas. In the judgment of any representative of the Sea City Work Camp, if the above-named camper should need immediate care and treatment as a result of any injury or sickness, I do hereby request, authorize, and consent to such care and treatment as may be given to said camper by any physician, hospital, or Sea City Work Camp representative.

Parent or Guardian Signature(Required)

Your Name
Your Name
Your Name

Payment Details

Camper Fees(Required)

Full Payment ($200)

Partial Payment ($100)

Payment Arrangement has been made with my Youth Dean and/or Pastor

Total

Payment Method(Required)

MasterCard

Visa

Supported Credit Cards: MasterCard, Visa

Card Number Expiration Date Security Code Cardholder Name