DANIELL BAPTIST ASSOCIATION

YOUTH WEEKEND 2022

Roll to YHWH your works and your purposes
shall be established. Proverbs 16:3

Sponsored by Daniell Baptist Association of Churches

YOUTH WEEKEND @ Brewton-Parker College
For all youth just completing 6th through 12th grade

July 15–16
Brewton — Parker College
Check-In: 8:00 AM at Gillis Gym
Pick-Up: 8:30 PM at Gillis Gym

Cost: $20 per camper
includes meals, snacks, t‑shirt, and all the missions,
discipleship, worship, fellowship, games and
good times we can pack into two days!

REGISTRATION DUE BY JULY 1st TO RECEIVE A T‑SHIRT
T‑Shirts will not be available for walk-up or late registrations

Once registration & payment are processed, you will receive a confirmation
CLICK HERE FOR PRINTABLE APPLICATION FOR SURGE SUMMER WEEKEND 2022

Campers First Name^*

Campers Last Name

Age^*

Gender^*

T‑Shirt Size (Adult Sizes Only)^*

Grade Just Completed

The Leadership Track is for High School Students (just completed 8th grade through 12th grade) that want to go deeper in study, take on more servant leadership responsibility, and share the Gospel.

Leadership Track:^*

Email^*

Address

Address Line 1 ^*

City ^*

State or Region ^*

Zip ^*

Parent/Guardian Name^*

Parent Cell Phone

Parent Home Phone

Parent Work Phone

Parent Email^*

Emergency Contact Name^*

Emergency Contact Phone Number^*

Please list any allergies/medications or other medical conditions:

Name of Insurance Company Covering Camper^*

Policy Number:

Name of Policy Holder:

Church You Attend^*

Member of Church?^*

By Checking & Tying your name below you agree: As a participant I agree to abide by all the rules set forth by the DBA SURGE committee. I further understand that failure on my part to comply with rules and directions given by the event organizers and youth leaders that are serving as counselors and chaperones of the event will merit my immediate dismissal at my parent/guardians expense.

Camper Check^*

I Agree

Camper Signature^*

Date^*

By Checking and Typing your name below you agree: As a parent/guardian I agree to allow my child to attend Surge. I understand that the event organizers, the DBA, individual DBA churches or Brewton-Parker College, will not be held liable for injuries incurred as a result of my child’s attendance at this event. Should injury or illness, other than minor, arise, I give my permission for medical care to be provided. I shall be fully responsible for payment of such cost. I also give my permission for any photographs taken of my child to be used for possible promotion purposes. I also give my permission for my child to be transported from Brewton-Parker College to participate in a local mission project.

Parent/Guardian Check^*

I Agree

Parent/Guardian Signature^*

Date^*

Summer Surge Weekend 2022 (incl PayPal fee)^*

Select a payment method^*

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