Registration Form

Registration Form

Youth Camp & Day Camp

NEW Updates and Important Information
1) One Form for ALL Summer Camps - day camps, youth camps, and specialty camps can all be registered for on this one form.

2) New Cabin/Lodging Selection System - we have a brand new amazing cabin selection system. We are NO LONGER taking cabin or camper requests over the phone or via email. To place your camper with a friend or sibling, contact the other camper(s) so both campers can select the same counselor/group in the cabin selection section. This new system will also allow for more reliable results and remove more human error, as well as, allow us to confirm that two campers want to be in the same cabin. *Note: Cabin Selection is only available for Junior Weeks and Teen Weeks.

3) Immunization Record - As in previous years, we are unable to register campers without an immunization record (or a letter of moral, religious, or medical exemption) due to health dept and state regulations. We are sorry for the inconvenience, but in order to complete the form, you will need to upload a copy of the camper's immunization record.

END OF NOTES SECTION
Camper Information
First Name*
Last Name*
Camper's Gender*

MaleFemale
Birthdate*

MonthDayYear
Camper's Age*
Camper Street Address*
City*
State*
Zipcode*
Camper's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Is this your camper's first week of camp at Camp Lamoka?*

YesNo
How did you here about Camp Lamoka
Camp & Cabin Selection

If camper is attending multiple weeks, select all weeks camper is attending (this feature may not work if a camper is attending both a specialty camp and a regular overnight youth camp). If a week is full, please contact our office, because there may be room on our waiting list. Our age ranges for our Summer camps is as follows: Starter's Day Camp: 4-6 years old; Junior Camp: 7-12 years old; Teen and Specialty Camps (12-18 years old). Cabin Selection is only available for Junior Weeks and Teen Weeks.
Camp Week Selection*
Camp Week Selection Calculation
Cabin Selection

No, I have no cabin preferenceYes, I would like to select a specific cabin for this camper
New Cabin Selection System
(Instructions and Information)

You have selected the "specific cabin" option above. Below are the remaining cabin/counselor options for the week you have selected. "girl counselor" and "guy counselor" are used as placeholders, because we have not confirmed all of our counselors for the coming Summer yet. Cabin Selections are NOT available for specialty camps (e.g., adventure, writing, horse, etc).

TO PLACE TWO OR MORE CAMPERS TOGETHER, please contact the other camper(s) and have them select the same option/group number below. We NO LONGER are taking requests for cabins or campers over the phone or by email. This new system will not only allow for more reliable results (you are guaranteed that you will be placed in the option/group you select below), but it will also allow us to confirm that campers requesting each other want to be in the same cabin.
Junior One Cabin Selector (girls)
Junior One Cabin Selector (guys)
Junior Two Cabin Selector (girls)
Junior Two Cabin Selector (guys)
Junior Three Cabin Selector (girls)
Junior Three Cabin Selector (guys)
Teen One Cabin Selector (girls)
Teen One Cabin Selector (guys)
Teen Two Cabin Selector (girls)
Teen Two Cabin Selector (guys)
Parent or Guardian Information
Parent/Guardian's Name*

First NameLast Name
Parent/Guardian's Phone Number*
Please enter a valid phone number.
Parent/Guardian's Email*
example@example.com
Emergency Contact Information*
Pick-Up Permission List*
Please list ALL (including yourself) individuals that have permission to pick up this camper from camp.
Camper Medical Information
Insurance Carries/Policy*
Immunization Record Or Immunization Exemption Letter Uploader*

*The NYS Dept of Health requires that all campers submit an immunization record OR an exemption letter (moral, religious, medical, etc...). Drag the record/letter into the uploader above or click within to search your files.
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Medical Needs/Conditions*

None of the following applyConcussions or a history of ConcussionsLife Threatening Condition(s)Disability (contact us to formulate a plan)A reason to see the nurse upon arrivalDietary Concerns/NeedsAllergiesMedications OR Over the Counter Medicines (that the camper is brining with them)
Life Threatening Condition(s) or Concussion(s) Details*
List and describe any and all life threatening conditions or history of concussions
Disability Details*
List and describe any and all disabilities. Camp Lamoka is not able to facilitate high, and some, moderate disabilities. Please contact our office with any questions and to establish a plan for your camper while they are here at camp
Dietary Details*
List and describe any and all dietary needs (e.g., gluten free, dairy free, etc...). Our chefs work hard to accommodate all the dietary needs of our campers.
Allergy Information*
Medication/Medicine Portal

NYS LAW & MED POLICY: All medicines and medications must be in original bottles and must be accompanied by a Dr Order. This Dr Order must be signed by the doctor or the doctor's office. This includes vitamins, tums, essential oils, and over the count medicines such as Advil. Controlled substances/medications MUST be in original bottle with Dr. Order (if possible, please only send the amount that is needed for this camper's week at camp). We stock the following OTC Meds, which means you do NOT need to bring them with you (BUT WE STILL NEED A DR ORDER TO GIVE THEM TO YOUR CAMPER): Tylenol, Benadryl, Motrin, Robitussin, Dimetapp, Cold and Allergy, Cough Drops, Caladryl, and Bacitracin Ointment. No Medicines will be administered without a Dr Order. If you do not bring the order AND if we do not have the order, your camper may not be able to stay at Camp.
Medication Information*
Drs Order Uploader

No OTC Medicine OR Medication can be administered without a Dr Order. Please drag and drop those orders into the box above OR click to search your files. If you need an Medication/OTC form, you can download and print one from the footer of our website. If you do not have the orders currently, you MUST submit them or bring them with you to camp.
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Payment, Discounts, and Extras

*Note: You must pay in full today to apply discounts and coupon codes.
Starter's Day Camp Payment Options*

Pay by the day ($55/Day)Pay by the week ($235/Week)
Youth Camp Payment Options*

Registration Fee ($50)Pay in Full (1 Week) ($399)Pay in Full (2 Weeks) ($648)Pay in Full (3 Weeks) ($897)
Lifeguard Camp Payment Options*

Registration Fee ($50)Pay in Full ($449)
Horse Camp Payment Options*

Registration Fee ($100) *Special Non-refundable Registration Fee for Horse CampPay in Full ($489)
Spiritual Emphasis Camp Payment Options*

Registration Fee ($50)Pay in Full ($199)
Pay by the day (how many days is this camper attending?)*

1 Day ($55)2 Days ($110)3 Days ($165)4 Days ($220)
Pay by the week (how many weeks is this camper attending?)*

1 Week ($235)2 Weeks ($470)3 Weeks ($705)

Discounts & Coupon Codes (Click Here)
Available Discounts (Select all that apply)

Sibling Discount ($20)Association Church Discount ($30)
Do you have a Coupon Code?*

NoYes
Coupon Code
*Properly entered coupon codes will reduce the total amount due at the bottom of this form
Coupon Amount
Scholarship or Coupon Source*
What church or organization awarded the coupon code

Discounts END
Add money to this camper's spending account?*

YesNo
Spending Money Amount*
Summer T-Shirt Options*

Add FREE Early Bird T-Shirt (before May 1st)Add T-Shirt ($18) (after May 1st)No T-Shirt
Shirt Size*
*Sizes are men's regular sizes
Day Camp Coupon Code
*Properly entered coupon codes will reduce the total amount due at the bottom of this form
Day Camp Coupon Amount
Cover the Card Processing Fee Associated with Your Registration? (2%)*

YesNo
Total Calculation
Total Due Today

prevnext( X )
USDDescription

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.

Should be Empty:

Registration Form

Camper Information

Camp & Cabin Selection

Parent or Guardian Information

Camper Medical Information

Medication/Medicine Portal

Payment, Discounts, and Extras