Lake Adventure Camp Registration

How'd you hear about our summer camps? *

Camper Name *

First

Last

Camper Birthdate *//

Camper Entering Grade: *

How many camps? *

Note: does not include cost of kits.

Grade 2-4 max 3 Camps
Grade 5-7 max 5 Camps
Grade 8-12 max 2 Camps

Choose Camps For Camper #1

Total

$ 0.00

Pick Up & Drop Off

Additional Services *

Early Drop Off - $40
Late Pick Up- $40
Early Drop Off and Late Pick Up - $80
Not needed

Please review Terms & Conditions for more information.

Total

$ 0.00

Alternate Individuals Allowed To Pick up.

Please list contact information for second parent or other approved individuals allowed to pick up your child. One per line.

Emergency Contact Information

Please enter the name of the parent or guardian who should be contacted in the case of an emergency.

Relationship *

Parent
Sibling
Relative
Friend

Name *

First

Last

Email *

Phone *

Address

Address Line 1

Address Line 2

City

State

Zip Code

Medical Information

Medical Condition

Please tell us about any medical issues we should be aware of, or any conditions that would prohibit a camper from participating in physical exercise or outdoor activities.

Allergies

Please list the camper's allergies if any.

Medications

Is the camper taking any medications? If yes, please list.

Special Needs

Does the camper have any special needs or learning disabilities that we should know about? This does not necessarily prevent participation.

Total & Payment

Total

$ 0.00

Credit Card

Card Number

Security Code

Name on Card

Expiration/

Important Information and Consent

Terms & Conditions *

I agree and give consent.

Please read the Important Information and Consent.

Choose Camps For Camper #1

Pick Up & Drop Off

Emergency Contact Information

Medical Information

Total & Payment

Important Information and Consent

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