Youth Camp 2026

June 8-12, 2026 | Please fill out this form and click submit.

For more information on Camp Refuge please visit: http://www.camprefuge.org/about.html

Grant Ripperger will be sending out updates through the parent email that is provided on this form.

*Jan 25-Mar 29 – Early Bird Registration $275 ($75 deposit)*

*Mar30-May 15 – Registration $350 ($175 deposit)*
*May 16-May 31- Late Registration $425 (Paid in full)*

*May 31 - Registration Deadline*

*May 27 - Leader meeting @ Westland Youth Garage 7:30 - 8:00 pm*

*May 31 - Mandatory Parent Meeting @ Westland Chapel 12:30PM-1:00 pm*

Student Name

Parent Email

This address will receive a confirmation email

Address

Parent Phone

Student Date of Birth

Shirt Size

Please select one option.

S M L XL XXL

Grade Completing

Please select one option.

12th 11th 10th 9th 8th 7th 6th

Name of School

Emergency Contact

Emergency Contact Number

Allergies

Medications you are currently taking:* Regarding medication, every person bringing medication to camp will need to include a signed Medication Form in a Ziploc bag with their medications. **Forms will be available at the parent meeting, May 31st.

Name of Insurance

Insurance Phone Number

Policy/Group/ID Number

Payment

Deposit (Early Bird) ($75) Early Bird Price ($275) Full Price ($325) Sponsor ($0)

Amount

Credit/Debit Card Number

Expiration Date/CVC

Name on Card

Card Billing Address

Description

June 8-12, 2026

Please fill out this form and click submit.

For more information on Camp Refuge please visit: http://www.camprefuge.org/about.html

Grant Ripperger will be sending out updates through the parent email that is provided on this form.

Youth Camp 2026

Description

Please Fix the Following