Camper Information

Camper Information
Camper's Name:*

First NameLast Name
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Current School: *
Camper's 2023-2024 Grade Level:*
Gender:*
T-Shirt Size:*
Please list any medical conditions that we should be aware of. Please leave the space blank if there are none:
Parent/Guardian Information
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com

Emergency Information
Emergency Contact's Name:*

First NameLast Name
Relationship:*
Emergency Contact's Phone Number:*
Please enter a valid phone number.
Informed Consent & Acknowledgment

I hereby authorize, in the case of a medical emergency, the camp directors to act according to their best judgement. I waive and release Valley Lutheran High School, the director, and instructors from liability for any injuries incurred while at camp.
BY ACKNOWLEDGING AND SUBMITTING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Payment
Registration Fee
prevnext( X )
Feel the Flame Registration Fee
$50.00 Quantity

Total

$0.00

Payment Methods

Debit or Credit Card

Please click one of the PayPal options to complete payment and submit the form.

Parent/Guardian Information