YOUTH CAMP June 22–26, 2019


You can down­load, print, and mail your reg­is­tra­tion in to the DBA Office, or you can fill out the below form & make your pay­ment online via Pay­Pal.
Spon­sored by the Daniell Bap­tist Asso­ci­a­tion and held at Brew­ton-Park­er Col­lege

 For all youth just com­plet­ing 6th through 12th grade
Total camp fee of $175.00 includes 4 nights, 11 meals, t‑shirt, tote bag, a draw­ing for door prizes, and oth­er items through­out the week.
Upon receipt of your appli­ca­tion you will receive a con­fir­ma­tion and infor­ma­tion sheet via e‑mail.

(Please note: If pay­ing online a Pay­Pal fee is added — $2.85 for the deposit, and $5.54 for the full amount)

Reg­is­tra­tion Dead­line and non-refund­able $85.00

Deposit due by:  Fri­day, June 8, 2020

**To be eli­gi­ble for door prizes, your appli­ca­tion must be in by the

dead­line of June 8.**

If you have ques­tions, please con­tact The Daniell Bap­tist Asso­ci­a­tion at 583‑2913 or
Lau­ra Hay at 583‑0160

If mail­ing, return appli­ca­tion and deposit by June 8, to:
Daniell Bap­tist Asso­ci­a­tion
P.O. Box 388
Ailey, GA 30410

Make checks payable to DBA Youth Camp
Print­able Appli­ca­tion: 2020 Sum­mer Surge Appli­ca­tion

Page 1
Address Line 1  *
City  *
State or Region  *
Zip  *

Please list your 1st and 2nd choic­es for a room­mate We will do our best to give you one of these, but keep in mind that if the per­son you choose has list­ed oth­er peo­ple, it may be dif­fi­cult to accom­mo­date every­one. Com­mu­ni­ca­tion with your cho­sen room­mate would help ensure your choice.

By Check­ing & Tying your name below you agree: As a camper I agree to abide by all the rules set forth by the DBA Youth Camp Lead­er­ship Team. 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 from the DBA Youth Camp at my parent/guardian’s expense.

By Check­ing and Typ­ing your name below you agree: As a parent/guardian I agree to allow my child to attend the 2019 DBA Youth Camp. I under­stand that the event orga­niz­ers, the DBA, indi­vid­ual DBA church­es or BPC will not be held liable for injuries incurred as a result of my child’s atten­dance at this event. Should injury or ill­ness arise, oth­er than minor injury, 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 of camp. I also give my per­mis­sion for my child to be trans­port­ed from Brew­ton-Park­er while par­tic­i­pat­ing in local mis­sion projects.


To Pay Bal­ance for Camper, please fill out the infor­ma­tion below then click Sub­mit.
(A Pay­Pal fee of $3.00 is added)