• Living River Summer Camp 2025- Youth, Elementary, and Creative Camp Registration

    Pressing the "back" button of your browser will reload the form, so only use the "back" and "next" buttons at the bottom of the form pages. Once you click "submit" you cannot go back to edit your submission, but the "save" option is great if you need to take a pause in filling out the form. Please contact Living River staff at office@livingriver.org if you have any questions about the registration process. We're looking forward to Summer Camp!
    • Camper/ Camper One's Personal Information 
    • Gender*
    • Select if Rising K or Graduated Senior
    • Is this the camper's first time at Living River Summer Camp?*

    • Camper/ Camper One's Medical Information

    • Does the camper have any allergies?*
    • Does the camper have any dietary restrictions?*
    • Does the camper have any chronic illness or conditions?*
    • Does the camper have any prescribed medication, an inhaler, or an epinephrine injection device (EpiPen)?*
    • Is your camper up to date on the immunizations required for public school?*
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    • Select the camp(s) that this camper will attend.*

    • Camper/Camper One's Family Information

    • Camper/Camper One's Parent/Guardian Information

    •  -

    • Camper/ Camper One's Emergency Contact Information

    • Is camper's emergency contact information the same as their parent/guardian information?*
    •  -
    •  -

    • Camper/ Camper One's Healthcare Provider

    •  -

    • Camper/ Camper One's Insurance Information

    • Upload a copy or take a picture of your insurance card below:

    • Browse Files
      Cancelof

  • Camper Two's Personal Information

  • Gender*
  • Select if Rising K or Graduated Senior
  • Is this the camper's first time at Living River Summer Camp?*

  • Camper Two's Medical Information

  • Does the camper have any allergies?*
  • Does the camper have any dietary restrictions?*
  • Does the camper have any chronic illness or conditions?*
  • Does the camper have any prescribed medication, an inhaler, or an epinephrine injection device (EpiPen)?*
  • Is your child up to date on the immunizations required for public school?*
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  • Select the camp(s) that this camper will attend.*

  • Camper Two's Family Information

  • Is your second camper's family information (parent/guardian, emergency contact, healthcare provider, insurance) the same as your first's?*
    • Copy of Camper One's Family Information 
    • Camper Two's Family Information 

    • Camper Two's Parent/Guardian Information

    •  -

    • Camper Two's Emergency Contact Information

    • Is camper's emergency contact information the same as their parent/guardian information?*
    •  -
    •  -

    • Camper Two's Healthcare Provider

    •  -

    • Camper Two's Insurance Information

    • Upload a copy or take a picture of your insurance card below:

    • Browse Files
      Cancelof

  • Camper Three's Personal Information

  • Gender*
  • Select if Rising K or Graduated Senior
  • Is this the camper's first time at Living River Summer Camp?*

  • Camper Three's Medical Information

  • Does the camper have any allergies?*
  • Does the camper have any dietary restrictions?*
  • Does the camper have any chronic illness or conditions?*
  • Does the camper have any prescribed medication, an inhaler, or an epinephrine injection device (EpiPen)?*
  • Is your child up to date on the immunizations required for public school?*
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  • Select the camp(s) that this camper will attend.*

  • Camper Three's Family Information

  • Is your third camper's family information (parent/guardian, emergency contact, healthcare provider, insurance) the same as your first two's?
    • Copy of Camper One's Family Information 
    • Camper Three's Family Information 

    • Camper Three's Parent/Guardian Information

    •  -

    • Camper Three's Emergency Contact Information

    • Is camper's emergency contact information the same as their parent/guardian information?*
    •  -
    •  -

    • Camper Three's Healthcare Provider

    •  -

    • Camper Three's Insurance Information

    • Upload a copy or take a picture of your insurance card below:

    • Browse Files
      Cancelof

  • Camper Four's Personal Information

  • Gender*
  • Select if Rising K or Graduated Senior
  • Is this the camper's first time at Living River Summer Camp?*

  • Camper Four's Medical Information

  • Does the camper have any allergies?*
  • Does the camper have any dietary restrictions?*
  • Does the camper have any chronic illness or conditions?*
  • Does the camper have any prescribed medication, an inhaler, or an epinephrine injection device (EpiPen)?*
  • Is your child up to date on the immunizations required for public school?*
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  • Select the camp(s) that camper four will attend.*

  • Camper Four's Family Information

  • Is your fourth camper's family information (parent/guardian, emergency contact, healthcare provider, insurance) the same as your first three's?
    • Copy of Camper One's Family Information 
    • Camper Four's Family Information 

    • Camper Four's Parent/Guardian Information

    •  -

    • Camper Four's Emergency Contact Information

    • Is camper's emergency contact information the same as their parent/guardian information?*
    •  -
    •  -

    • Camper Four's Healthcare Provider

    •  -

    • Camper Four's Insurance Information

    • Upload a copy or take a picture of your insurance card below:

    • Browse Files
      Cancelof

  • Camper Five's Personal Information

  • Gender*
  • Select if Rising K or Graduated Senior
  • Is this the camper's first time at Living River Summer Camp?*

  • Camper Five's Medical Information

  • Does the camper have any allergies?*
  • Does the camper have any dietary restrictions?*
  • Does the camper have any chronic illness or conditions?*
  • Does the camper have any prescribed medication, an inhaler, or an epinephrine injection device (EpiPen)?*
  • Is your child up to date on the immunizations required for public school?*

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  • Select the camp(s) that camper five will attend.*

  • Camper Five's Family Information

  • Is your fifth camper's family information (parent/guardian, emergency contact, healthcare provider, insurance) the same as your first four's?
    • Copy of Camper One's Family Information 
    • Camper Five's Family Information 

    • Camper Five's Parent/Guardian Information

    •  -

    • Camper Five's Emergency Contact Information

    • Is camper's emergency contact information the same as their parent/guardian information?*
    •  -
    •  -

    • Camper Five's Healthcare Provider

    •  -

    • Camper Five's Insurance Information

    • Upload a copy or take a picture of your insurance card below:

    • Browse Files
      Cancelof

  • Payment and Consent

  • You may choose:

    • Pay now (either the full amount or the full amount minus the Presbytery of Sheppards and Lapsley scholarship).
    • Be billed your total by Living River after Summer Camp is over (whether you apply for a scholarship or plan to pay the full amount).
    • Bill my chuch if you have made arrangements for your church to cover the cost of Summer Camp.
    • Full scholarship if you are a camper that lives in Wilcox Co.

    Scholarships- The Presbytery of Sheppards and Lapsley offers a limited number of $200 scholarships for any camper ($75 for You & Me campers). You must complete the Presbytery of Sheppards & Lapsley application to be considered for their scholarship. If you plan to apply for a camp scholarship, please select "yes" below and $200 per camper will be taken off your total. If the Presbytery never receives your application, you will be billed the remaining total after Summer Camp. To complete the scholarship application go to http://pslpcusa.org/summer-camp/ and click the "Apply for Scholarship" button.

    Additional Assistance- If you need additional financial assistance beyond the Presbytery scholarship, please email office@livingriver.org.

    Bring a Friend Discount- If you are inviting new friends to Living River this Summer for the "Bring a Friend Discount," choose to be billed by Living River after Summer Camp so that your total reflects your discount. New friends need to both complete registration and participate in camp.

  • Payment Options*
  • Do you plan to apply for the Presbytery of Sheppards and Lapsley $200 scholarship for your camper(s)?*

  • Total to Pay through PayPal:

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    USD

  • Photos/Publicity

    I understand that photos of my child or me may be used by Living River for publicity purposes in print or on social media. Names will not be printed. If I do not wish photographs of my child to be used in this capacity I will notify staff, in writing, before the beginning of the camp session. 

  • Informed Consent and Acknowledgement

    I, the undersigned, being the parent or legal guardian of the child named above permit my child to participate in all camp activities and I will hold Living River harmless in case of injury or illness. I understand that I will be notified in case of medical or surgical emergency involving my child. However, in the event that I or persons I have designated cannot be reached, I authorize the calling of a doctor and the providing of necessary medical services in the event my child is injured or becomes ill. I understand Living River will not be responsible for medical expenses incurred, but that such expenses will be my responsibility as parent/guardian. I will notify the camp director of any problems or restrictions which would affect participation in normal camp activities prior to the camp period. I also understand that the adult supervisors reserve the right to restrict my child from any activity that they do not feel is within the physical capabilities of my child. I agree to abide by the decisions of the director(s) in the case of sending the camper home due to illness or fails to abide by the camp rules.

  • Confirmation

    Your electronic signature below is equally as binding as an original, manual signature. Your signature applies the above consent forms to every camper you have registered. 

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