Athletic Camps

1

Child #1 Information* This field is required.

First Name

Last Name

Age

Birthdate

Grade Entering This Fall

2

Child #1 - Camp Selection* This field is required.Please indicate your camp selection(s) below

Girls Soccer: 6th- 12th grade, Aug 1-4, 6:00-8:30 p.m. Cost: $125. Register by May 31 for $105.

Boys Soccer: High School, Aug. 8-11, 6:00- 9:00 p.m. Cost: $125. Register by May 31 for $110.

Boys Basketball: 4th-10th grade, June 27- 30, 9:00am-3:00 p.m. Cost: $165. Register by May 31 for $150.

Tennis: High School, Aug. 8- 12, 9:00 -3:00 p.m. Cost: $145. If signed up by June 1st will get a t-shirt

Field Hockey: Youth 3rd-8th grades, Aug. 1- 4 8:30-10:30 a.m. Cost: $125

Field Hockey : High School, Aug. 8- 11, 8:00-11:00 a.m. Cost: $125

JH Boys Soccer: rising grades 5th-8th, Aug. 8-11, 5-8:00 p.m. Cost $125 or $110 by 5/31

3

Child #1 - T-shirt SizeChildren who participate in the Blazers' Boys Basketball Camp OR the Youth Girls' Field Hockey Camp will receive a t-shirt with his/her registration. Please select your child's size.

Youth M

Youth L

Youth XL

Adult S

Adult M

Adult L

4

Child #1 - Health Information

Please indicate any allergies (environmental, food, or medications)

Please indicate any other medical conditions that we should be aware of

Does your child require an EpiPen to treat an allergy? (If yes, please notify the camp leader at registration)

Does your child use an inhaler for asthma? (If yes, please notify the camp leader at registration)

5

Child #1 Photo Permissions - I hereby give permission for my child to be included in photographs used for summer camp publicity.* This field is required.

YESNO

6

Do you have another child to register for an athletic camp?* This field is required.

YESNO

7

Child #2 Information

First Name

Last Name

Age

Birthdate

Grade Entering This Fall

8

Child #2 - Camp SelectionPlease indicate your camp selection(s) below

Girls Soccer: 6th- 12th grade, Aug 1-4, 6:00-8:30 p.m. Cost: $125. Register by May 31 for $105.

Boys Soccer: High School, Aug. 8-11, 6:00- 9:00 p.m. Cost: $125. Register by May 31 for $110.

Boys Basketball: 4th-10th grade, June 27- 30, 9:00am-3:00 p.m. Cost: $165. Register by May 31 for $150.

Tennis: High School, Aug. 8- 12, 9:00 -3:00 p.m. Cost: $145. If signed up by June 1st will get a t-shirt

Field Hockey: Youth 3rd-8th grades, Aug. 1- 4 8:30-10:30 a.m. Cost: $125

Field Hockey : High School, Aug. 8- 11, 8:00-11:00 a.m. Cost: $125

JH Boys Soccer: rising grades 5th-8th, Aug. 8-11, 5-8:00 p.m. Cost $125 or $110 by 5/31

9

Child #2 - T-shirt SizeChildren who participate in the Blazers' Boys Basketball Camp OR the Youth Girls' Field Hockey Camp will receive a t-shirt with his/her registration. Please select your child's size.

Youth M

Youth L

Youth XL

Adult S

Adult M

Adult L

10

Child #2 - Health Information

Please indicate any allergies (environmental, food, or medications)

Please indicate any other medical conditions that we should be aware of

Does your child require an EpiPen to treat an allergy? (If yes, please notify the camp leader at registration)

Does your child use an inhaler for asthma? (If yes, please notify the camp leader at registration)

11

Child #2 Photo Permissions - I hereby give permission for my child to be included in photographs used for summer camp publicity.

YESNO

12

Do you have another child to register for an athletic camp?

YESNO

13

Child #3 Information

First Name

Last Name

Age

Birthdate

Grade Entering This Fall

14

Child #3 - Camp SelectionPlease indicate your camp selection(s) below

Girls Soccer: 6th- 12th grade, Aug 1-4, 6:00-8:30 p.m. Cost: $125. Register by May 31 for $105.

Boys Soccer: High School, Aug. 8-11, 6:00- 9:00 p.m. Cost: $125. Register by May 31 for $110.

Boys Basketball: 4th-10th grade, June 27- 30, 9:00am-3:00 p.m. Cost: $165. Register by May 31 for $150.

Tennis: High School, Aug. 8- 12, 9:00 -3:00 p.m. Cost: $145. If signed up by June 1st will get a t-shirt

Field Hockey: Youth 3rd-8th grades, Aug. 1- 4 8:30-10:30 a.m. Cost: $125

Field Hockey : High School, Aug. 8- 11, 8:00-11:00 a.m. Cost: $125

JH Boys Soccer: rising grades 5th-8th, Aug. 8-11, 5-8:00 p.m. Cost $125 or $110 by 5/31

15

Child #3 - T-shirt SizeChildren who participate in the Blazers' Boys Basketball Camp OR the Youth Girls' Field Hockey Camp will receive a t-shirt with his/her registration. Please select your child's size.

Youth M

Youth L

Youth XL

Adult S

Adult M

Adult L

16

Child #3 - Health Information

Please indicate any allergies (environmental, food, or medications)

Please indicate any other medical conditions that we should be aware of

Does your child require an EpiPen to treat an allergy? (If yes, please notify the camp leader at registration)

Does your child use an inhaler for asthma? (If yes, please notify the camp leader at registration)

17

Child #3 Photo Permissions - I hereby give permission for my child to be included in photographs used for summer camp publicity.

YESNO

18

Parent(s)/Guardian(s) Information* This field is required.

First Name

Last Name

19

Home Address* This field is required.

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

20

Contact Phone Numbers* This field is required.If no alternate number, enter N/A

Primary phone number

Name of person at this number

Alternate phone number

Name of person at this number

21

Email* This field is required.to receive camp details, updates from the camp leader. If no secondary email, enter none@none.com

Primary Email

Secondary Email

22

Name & Relationship to Child (Authorized to Pick Up)(Relationship = ie Grandparent, Family Friend, Aunt)

1) Full Name

1) Relationship

2) Full Name

2) Relationship

3) Full Name

3) Relationship

4) Full Name

4) Relationship

23

By completing and submitting this application, I, the parent/guardian, hereby give permission for my child(ren) to participate in all camp activities. I assume all risk incidents to my child(ren)'s participation and release Lancaster Mennonite School, its employees, and volunteers from all liability, claim, expenses and actions which may arise from injury or harm to the child(ren) as a result of camp participation.

In the event of a medical emergency, I authorize Lancaster Mennonite School to designate a hospital, physician or emergency personnel to provide care (including hospitalization, if necessary) to the child(ren) and release Lancaster Mennonite School from any liability for injury or harm to the child(ren) which may result from this medical care. I understand that responsibility for payment of such medical care will be mine and certify that the child(ren) is/are covered by adequate medical insurance.

24

Medical Insurance Information* This field is required.

Medical Insurance Company

Policy Number

Policyholder's Name (Parent/Guardian)

25

Emergency Contact* This field is required.In the case of an emergency, the camp leader will attempt to contact parents/guardians first. However, if a parent/guardian cannot be reached, please provide the name and phone number of an emergency contact.

Full Name

Contact Number

26

Enrollment is limited for some camps. A non-refundable $50 deposit per child per camp is due with your application in order to hold a spot in each camp until May 15.

PLEASE NOTE: Full payment for all camps is due 2 weeks before the start of camp.

If enrollment is not sufficient to run a camp, the deposit for that camp will be refunded.

Families have the option to pay by credit card or check.

Checks should be made payable to Lancaster Mennonite School and mailed to: Lancaster Mennonite School, ATTN: LM Summer Camps, 2176 Lincoln Hwy East, Lancaster, PA 17602. Please reference your child(ren)'s name(s) and name of camp with your check payment.

27

Parent/Guardian Signature* This field is required.By signing, I confirm that I have read and understood the payment and policy information. The information provided on this registration form is true and correct, including the indicated responses to permission forms, health information, medical insurance and photo permissions.

ClearUse mouse (or fingertip with mobile devices) to sign

28

Number of Participants* This field is required.Please indicate how many from your family will participate in each camp. This will help calculate your total amount due.

# of Blazers Boys Basketball Participants

# of High School Girls Soccer Participants

# of High School Girls Field Hockey Participants

# of Youth Girls Field Hockey Participants

# of High School Boys Soccer Participants

# of High School Girls Volleyball Participants

# of JH Boys Soccer Particpiants

29

Total Boys Basketball Camp

30

Total Cost for Camps

31

Please choose your Payment Option

Credit Card

Check

32

Credit Card Payment* This field is required.Please enter the amount you owe below. This should be the full price.

Athletic Camps

USD

+ OR enter a custom value

Credit Card

First Name

Last Name

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