LifeWise [FIELD TRIP] Permission Slip

LifeWise Lakewood Summer Camp Permission Form

July 28th to Aug. 1st, 2025, | Jacksontown UMC | 9am to 1pm each day
When: July 28th to August 1st 9am-1pm each day

Where: Jacksontown UMC, 9350 Jacksontown Rd, Thornville, 43076

Who: Open to any student from any school district that is entering 1st - 5th grade.

Admission: $15per day for one, $25 per day for two, and $35 per day for 3. "Space is limited to first 40 children". Please provide a mid-day snack for your child.

Deadline to register: July 14th

How to Pay: Go to our website lifewise.org/lakewoodoh and click on donate click on give once and inter your information or you can pay at the door.

If you have any questions please reach out to Doyle Pertuset LifeWise Lakewood Director 740-281-4297, lakewoodoh@lifewiseacademy.org
Student Information

Please fill out for each student who will be participating.
Student Name*

First NameLast Name
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent Information
Name*

First NameLast Name
Email Address*
Phone Number*
Please enter a valid phone number.
* Please note any dietary restrictions, medical conditions or anything else we should be aware of.
I grant permission to for my student to participate in this Summer Camp conducted by LifeWise Lakewood. I have read and fully understand the terms of the Release and Waive found at lifewise.org/release and I waive the right to sue LifeWise Academy.*

YesNo
I consent to the photography or video of my student while on the field trip, for promotional purposes.*

YesNo
Signature*

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Should be Empty:

LifeWise Lakewood Summer Camp Permission Form

Student Information

Parent Information