2013 Daycamp Application Form

Destiny Youth Ranch, PO Box 92, Alvord, IA 51230

Dates to be Announced for 2013............

Lunch will be provided. The kids are encouraged to bring snacks to share with the other guests. Be sure to wear close-toed shoes, with a 1” heel if possible, blue jeans and a t-shirt. No shorts or tank tops. Bring a jacket or sweatshirt for evening or cooler weather.

Name:______________________________________Age:_________________

Address:__________________________________Phone:_________________

Parents Name:____________________________________________________

Weight_____________________                    Height________________________

Date of last tetnus shot:_____________________________________________

We give Destiny Youth Ranch permission to take pictures during camp and to use them on their website or for further promotion of the DYR activities. Our child has permission to attend and participate in the DYR day camp marked above.

Signature:____________________________________ Date:______________

(Must be signed by an adult parent or guardian 18+)

___Enclosed is the $35 camp fee

___Enclosed is the Emergency Medical Treatment Form

___Enclosed is the DYR Waiver Form for 2012

___I would like more information regarding scholarships for camp