Camp Lu Lay Lea Registration Form

CAMP LU LAY LEA REGISTRATION FORM
Participant Name*

First NameLast Name
Are you this person’s legal guardian? You must be this person’s legal guardian to register someone under 18 years of age.*

Yes
Participant's Birth Date*

MonthDayYear
Date
Participant's Current Grade*
Participant's Sex*

MaleFemale
Home Church and City*
Home School and City*
Please list ONE or TWO friends that your child would like to bunk with in a cabin. Campers are placed in cabins according to gender and age. Groups of campers are not GUARANTEED to be placed in the same cabin.*
Choose Your Camp Week*

Week 1 - June 22-28Week 3 - July 6-12Week 4 - July 13-19Week 5 - July 20-26Week 6 - July 27-Aug 2
How did you hear about Camp Lu Lay Lea?*
Parent/Guardian Information
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Birthdate*

MonthDayYear
Date
Home/Cell Phone*
Please enter a valid phone number.
Work Phone*
Please enter a valid phone number.
Additional Parent/Guardian Information
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Birth Date

MonthDayYear
Date
Home/Cell Phone
Please enter a valid phone number.
Work Phone
Please enter a valid phone number.
Emergency Contact Information (Not Already Listed)
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Date*

MonthDayYear
Date
Home/Cell Phone*
Please enter a valid phone number.
Work Phone*
Please enter a valid phone number.
Relationship to Camper*
Insurance Information
Insurance Company*
Insurance Phone Number*
Subscriber Name*
Policy Number*
Medical/Allergy Information
Is your camper up to date on immunizations?*

YesNo
Last date of Tetnus Shot*

MonthDayYear
Date
Does your camper have any medical conditions or special needs?*
Does your camper have self-administered medication?*

YesNo
Please list all self-administered medications.
Does your child have limitations or need adaptations to participate in daily/evening camp activities? *
Does your camper have allergies and/or dietary restrictions? *
Does your child have daily medication he/she takes? Please list all medications. Medications must be in the original container/prescription bottle and will be administered by our Health Directors at the time of need.*
Does your camper have a nut allergy?*

YesNo
Nut Allergy Description
Doctor/Pediatrician Name*
Doctor/Pediatrician Phone Number*
Child Pick Up

List of people other than the parent/guardian listed above have permission to pick up your camper. Valid identification will be required at pick-up (State or Federal issued I.D.)
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Name

First NameLast Name
Phone Number
Please enter a valid phone number.
Name

First NameLast Name
Phone Number
Please enter a valid phone number.
Affirmation

I affirm and certify that all the information and answers to questions and waivers
herein are complete, true, and correct to the best of my knowledge. I understand
that any misrepresentation, falsification, or omission of any facts called for in the
application may render this application void and will be cause for termination,
whenever discovered.
Signature*

Clear
Today's Date*

MonthDayYear
Date
Medical Waiver

I give permission for my child to attend Camp Lu Lay Lea and to participate
in all camp activities. In case of emergency, the health director may give
routine treatment, or a physician selected by the camp director may
hospitalize or secure proper treatment, for said child, including injection,
anesthesia, or surgery. The health history completed is correct to the best
of my knowledge, and I understand it is requested for the benefit of my
child.
Signature*

Clear
Today's Date*

MonthDayYear
Date
Behavior Contract (Parent/Guardian)
Keeping in mind that Camp Lu Lay Lea is a Christian camp; inappropriate
behavior, language, and actions will not be tolerated. Here are the written
guidelines we expect to be followed.

1. No fighting or bullying.
2. No foul or offensive language.
3. No inappropriate sexual behavior.
4. No cell phones - we understand that this will be hard for all of us
(even staff), but for many reasons, we ask that cell phones not be
brought to camp. If a camper brings a cell phone to camp, the cell
phone will be taken and locked up until it can be given to the parent
at check-out.

5. Campers will not be involved with smoking, vaping, or alcohol use while at Camp Lu Lay Lea.

Not following these guidelines could result in dismissal from camp without
refund.

As a parent I agree to my child following the rules and if not followed
understand that I may have to pick him/her up early and forfeit camp fees.
Signature*

Clear
Today's Date*

MonthDayYear
Date
Behavior Contract (for Camper to read/sign)
Keeping in mind that Camp Lu Lay Lea is a Christian camp; inappropriate
behavior, language, and actions will not be tolerated. Here are the written
guidelines we expect to be followed.

1. No fighting or bullying.
2. No foul or offensive language.
3. No inappropriate sexual behavior.
4. No cell phones - we understand that this will be hard for all of us
(even staff), but for many reasons, we ask that cell phones are not
brought to camp. If a camper brings a cell phone to camp, the cell
phone will be taken and locked up until it can be given to the parent
at check-out.

5. Campers will not be involved with smoking, vaping, or alcohol use while at Camp Lu Lay Lea.

Not following these guidelines could result in dismissal from camp
without a refund.
Camper Signature*

Clear
Today's Date*

MonthDayYear
Date
Covid-19 Waiver
To prevent the spread of Coronavirus (COVID- 19), we are asking participants to closely monitor their children, and themselves, prior to attending Camp Lu Lay Lea. Camp Lu Lay Lea will be following all guidelines and recommendations given by the CDC, District#2 Health Department of Michigan, trustee policies, and the State of Michigan. If you or your child starts showing symptoms or is traveling outside of the country, please contact the camp director prior to camper drop off by phone or email. Contact: director@camplulaylea.com.

Any camper or staff that is showing symptoms while at camp will be given a COVID rapid test. In the event that the rapid test comes back positive, the camper/staff will be isolated, and the parent/guardian must come to camp to pick up their camper/staff member. Contact tracing will be conducted according to the CDC guidelines. For campers/staff who are considered a close contact, the camper/staff will be quarantined until a parent/guardian can pick up their camper/staff member. All other camp families will be notified by email/and or letter. There is no vaccine requirement and Camp Lu Lay Lea will not be held liable for any coronavirus-related issues. If you agree to this waiver, then please sign.
Signature*

Clear
Today's Date*

MonthDayYear
Date
Video/Photo Release
I hereby give permission for images of my child, captured through video,
photo, and digital camera to be used solely for the purposes of Camp Lu
Lay Lea promotional material and publications, and waive any rights of
compensation or ownership thereto. This permission includes images of
my child in the weekly video that will be made and posted for campers to
view.
Signature*

Clear
Today's Date*

MonthDayYear
Date
Camper Registration Options - Registration includes Camp Store funds.
Camper Registration

Camper registration options are Pay in Full or Pay Deposit with remaining balance due one month prior to camp check-in date. Camp registration cost varies by week. Camp registration includes Camp Store funds. Camp t-shirt and sweatshirt purchases are available as an add-on option.

BOY - Pay in Full Boy camper full payment

$420.00

GIRL - Pay in Full Girl camper full payment

$420.00

BOY - Pay DepositBoy camper pay deposit now, balance due 1 month before check-in date

$100.00

GIRL - Pay DepositGirl camper pay deposit now, balance due 1 month before check-in date

$100.00

Camp Lu Lay Lea T-Shirt

$15.00

Camp Lu Lay Lea Sweatshirt

$30.00

Enter coupon

Total

$0.00

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Should be Empty:

Camper Registration