Sample Camp Registration


Family Camper's Personal Information

Family Camp Ages: Adults who are 18 years of age and up and children who are newborn through 6 years of age (Note: Children who are 6 years old may register as a Jr. Camper. If they choose to register in Jr. Camp, you will need to obtain the appropriate Junior Camp Registration Form - DO NOT use this form.)

Spouse & Children Information:

List Spouse And Children (only newborn through 6 years of age) If They Are Family Campers Who Are Lodging With You: (Note: All other family members must fill out a separate form for the appropriate camp they are registering with.)

U.P.C.I. Pastor's Information:

Note: If you do not attend a United Pentecostal Church, you must obtain the signature of the U.P.C.I. Sectional Presbyter where you reside.

Lodging Options

Note: Newborn babies under 2 years of age are FREE and children who are 2-6 years of age are HALF PRICE. Meals are included in those prices. These rates apply to children staying in the cabins, the small motel unit, or the trailers only.


Clear Signature

Special Information

If you have any questions or concerns, call Talina Lutz, Camp Registrar, at (570)578-9986. Please DO NOT make Special Request via Social Media. All families will be required at Check-In to pay a $20.00 Cleaning Deposit Fee which will be refunded at the time of Check-Out upon inspection of the cabin.**
All persons (registered campers as well as unregistered guests) are subject to all the rules and regulations as stated in both the PA District Camp Guidelines/Policies and those established by the Roxbury Holiness Camp.

Each U.P.C.I. pastor should make certain their church members who will be registered campers (or non-registered guests throughout the week) have read and understand the following guidelines before they arrive at the campgrounds.

The purpose and intent of all PA District Camps shall be to provide campers with a setting for worship-related activities that promote evangelism, Christian growth, and spiritual renewal, and to provide an environment that permits wholesome activity and fellowship for the strengthening of personal and family relationships in the spirit of unity and true holiness.

1. All registering campers must check in at the registration office upon arrival at the campgrounds (even if they already know their lodging assignment). All persons staying overnight on the campgrounds, regardless of accommodations, must be registered with the registrar.

2. A Registration Form and Medical Emergency Form must be completed for each registered camper and submitted with their registration fee. The registrar will first assign lodging to those who have submitted their completed forms along with the appropriate fees; lodging cannot be assigned until the registration fee has been paid. Telephoned requests from potential campers to reserve lodging cannot be guaranteed by the registrar.

3. As a courtesy, PA District licensed ministers will have until May 31st to register and reserve lodging. After that date, ministers who register will be assisted on a first-come first-served basis as any other camper. Ministers should not attempt to pressure the registrar or any district official regarding the cut-off date for reserved lodging. As in any instance, outside of special health needs, the registrar cannot 11bump 11 someone else out of already assigned lodging to accommodate ministerial requests made after the cut-off date.

4. Registrants who do not attend a United Pentecostal Church must obtain the signature (on their registration form)
of the U.P.C.I. sectional presbyter where they reside.

5. Anyone who is only registering for specific nights instead of the full week must pay a pro-rated amount for each night. That pro-rated amount will include meals in the dining hall, lodging and all camp sessions if you are staying in a cabin, the small motel unit, a trailer, or the Byers Conference Center. If you are staying in an RV or tent with other people, only one person will have their meals included in the pro-rated amount. All others must pay $5.00 per meal (meal tickets are available at the registration office).

6. Non-registered Junior and Senior Campers must pay $10/day in order to participate in the classes/services. In the event they missed orientation on the first day of camp, their parent/guardian must speak to the Sunday School Director or Youth President for instructions as to what is expected of the student(s). They must also purchase meal tickets ($5/meal) at the registration office if they would like to eat in the dining hall.
Non-registered campers who want to attend the Family Camp or Hyphen Camp classes/services will not be charged a fee. However, if they would like to eat in the dining hall, they must purchase meal tickets ($5/meal) at the registration office.
Please do not eat in the dining hall if you are a day visitor who has not purchased a meal ticket or if you are a registered camper whose registration package did not include meals.

7. For insurance and safety purposes, registered campers who need to leave the campgrounds overnight must notify the registrar of their departure and anticipated return time. If a parent/guardian needs to unenroll their young person (under the age of 18 years) from Jr., Sr., or Hyphen Camp, they must sign them out at the registration office and must also inform their counselor as well.

8. All Jr. and Sr. Campers must lodge with their appropriate age group in the bed they are assigned; they cannot stay with their parents/guardians. The only exceptions that will be made are for medical conditions or disabilities that require a child/young person to have parental/guardian assistance.

9. Jr. Campers are not allowed to leave the campgrounds for off-campground activities. Sr. or Hyphen Campers (under the age of 18) are not allowed to leave the campground for off-campground activities unless their registration form has been signed by their parent/guardian where it states, 111 give my young person permission to participate in any supervised off-campground activities."

10. Due to liability and safety concerns, unregistered guests must leave the campgrounds each night by 12 midnight (this includes Individuals who arrive Thursday night to transport campers home). If unregistered guests do not leave the campgrounds by 12 midnight, camp security may report them to the Camp Director, and an effort will then be made to contact the pastor of individuals who refuse to cooperate with campground policy. Those who persist in refusing to leave the campgrounds may be reported to the police, whether they are members ofa PA District, U.P.C.I. church or not.

11. Requests for a refund of registration fees must be addressed to the camp registrar. Final approval will come from the PA District Superintendent or the PA District Secretary. No-shows that are non-emergency situations and who do not cancel at least one week prior to camp will not receive a refund. No exceptions. Refunds will be given in the following instances only:
a. Paid campers who have agreed to serve as staff members for the duration of the camp.
b. Immediate emergencies.
c. Non-emergency situations made at least one week prior to the week of camp. (Note: A $10.00 fee will be charged in this situation.)

1. Each camper is responsible for his/her own: sleeping bag, sheets, blankets, pillow, towels, washcloths, personal hygiene items, clothing, bible, pens, notebook, spending money for the concession stand or camp store, etc. Personal property that is lost is the responsibility of the camper.

2. Jr. Campers must follow the daily schedule as established by the Jr. Camp director. Jr. Campers must report to their assigned counselors and cabins/dorms immediately following dismissal from the evening snack.

3. All Jr. and Sr. Campers remaining on the campgrounds th rough Thursday night must remain under the supervision of their camp counselor. However, if their parent/guardian wants them to spend Thursday night with them in their cabin, the parent/guardian must tell their child's counselor, and they must remain under parent/guardian supervision at all times.

4. An announcement will be made to signify the end of the canteen fellowship time after the evening services. At that time, all registered campers should proceed to their appropriate lodging.

5. Hyphen Campers who participate in any Sr. or Family Camp functions must abide by the rules pertaining to each function. This includes attention to canteen dismissal times and the 12 midnight curfew.

6. Although there is no "lights out" policy for Family Campers, it is expected that they will refrain from loud fellowshipping after midnight.

1. At no time are unmarried couples permitted to have physical contact of any kind and pairing off of unmarried couples in secluded or unlighted areas is not permitted. We reserve the right to dismiss unmarried campers for these offenses including participation in physical displays of affection or sexual promiscuity.

2. Unmarried campers are not permitted to enter or linger around cabins/dorms of the opposite sex.

3. Playing unwholesome games and/or music is not permitted on the campgrounds. Gambling is also prohibited.

4. Foul language is not permitted on the campgrounds.

5. Anyone found in possession of or in use of illegal substances such as drugs, tobacco products, alcoholic beverages, firearms, knives or other weapons, fireworks, or explosives is subject to immediate dismissal from the campground on the first offense and we will contact the police should we deem it necessary.

Understanding that Godly living should characterize the life of every child of God, a dress code exists for all registered campers.


No immodest, sheer, or tight-fitting clothing will be allowed. This includes ball uniform pants and sweatpants.
No shorts or jams. All pants must be full-length. No muscle shirts or sleeveless shirts of any kind will be allowed -sleeve length must be to mid­ upper arm.
No low-cut shirts are allowed. All shirts must be buttoned so the neckline is modest
All shirts must cover your stomach and back when your arms are raised or lowered.
All dress shirts must be tucked into the waistline of the pants.
No suggestive slogans or pictures shall be allowed
on clothing or elsewhere.
No make-up, necklaces, bracelets, earrings, body piercing jewelry, or anything of this nature is allowed.
Hair must be neatly trimmed before arriving on the campgrounds. This means hair must be off the collar and ears.


No immodest, sheer, or tight-fitting clothing will be allowed.
No shorts, pants, or slacks. Only culottes with front and back panels will be allowed.
All culottes, dresses, and skirts must be at least to the bottom of the knee.
All splits in skirts and dresses (whether in front, back or sides) must be sewn to the bottom of the knee or below. Knees should be covered at all times whether sitting or standing.
No sleeveless or capped-sleeved tops - sleeve length must be to mid-upper arm.
No low-cut blouses, tops or dresses are allowed. All tops must be buttoned so the neckline is modest
All tops must cover your stomach and back when your arms are raised or lowered.
No suggestive slogans or pictures shall be allowed on clothing or elsewhere.
No make-up, necklaces, bracelets, earrings, body piercing jewelry, or anything of this nature is allowed.

1. A camp security team will be appointed by the Camp Director. The duty of the security team will be to see that campground policy is carried out.

2. All situations that arise within the jurisdiction of a particular camp must first be reported to the director of that particular camp or his/her designee. A violation of camp policy or a failure to keep the spirit and purpose of the camp may call for disciplinary action. This will be administered at the direction of the director of the appropriate camp with the final authority in all matters being the PA District Board, U.P.C.I.

3. Camp Directors and/or the PA District Board may add auxiliary rules or conditions as they deem necessary for the operation of the camp.

4. Property that is willfully destroyed in any area of the camp or its facilities must be paid for by those responsible, or in the case of dependent children, the parent/guardian of those responsible.

5. Each cabin and trailer is the private property of the owner. Therefore, Roxbury Camp Board of Directors has asked that no rearrangement of furniture in any camp facility be done without authorization of the Roxbury Camp Facility Director. See the PA District, U.P.C.I. Camp Director if there is a valid need to rearrange any furniture.

6. Pets, except for those designated as assist animals, may not be brought onto the campgrounds.

7. Due to safety concerns, shoes must be worn at all times when outdoors.