LifeSports Form

2025 LifeSports Registration

Please complete a registration form for each child.
Camper's Name*

First NameLast Name
Birth Date*

MonthDayYear
Age*
Grade (Fall 2025)*
MaleFemale
Parent's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Name*

First NameLast Name
Parent/Guardian Cell*
Format: (000) 000-0000.
E-mail*
example@example.com
Alternate Parent/Guardian Name (optional)

First NameLast Name
Alternate Parent/Guardian Cell (optional)
Format: (000) 000-0000.
Emergency Contact Person*

First NameLast Name
Relationship*
Emergency Contact Cell*
Format: (000) 000-0000.
YesNo
Home Church, if any
Please initial below if you would like to opt OUT of having your child's photo and/or video used in public or online communications related to LifeSports.
Does the camper have any allergies, chronic illness, inhaler or medical conditions that may affect participation in camp? If yes, please describe and list any necessary details.*

Camp Selections

For camp questions, contact Pam at pam.ostrander@outlook.com or 847.207.8773.
Session 1 (9:30-11:30 AM) $40/week
Session 1 Cost
Session 2 (12:30-2:30 PM) $40/week
Session 2 Cost
Session 3 (3:00-5:00 PM) $40/week
Session 3 Cost
Yes (Campers Must Bring Their Own Lunches)No
Lunch Cost
Please list any additional information about your child or his/her camp schedule that would be helpful for us to know in advance.
Total Cost (calculated from above choices)
Campers who attend both afternoon camps will have free recess supervision from 2:30-3:00 PM.
Credit/DebitCheck (Payable to Living Waters, Attn: LifeSports) (Mail to Living Waters, 525 N. Atkinson Road, Grayslake, IL 60030 or drop off M-Fri from 9-5 PM.)Staff Scholarship (Adults or youth 12yo and older. If interested, please contact Pam Ostrander at pam.ostrander@outlook.com or 847-207-8773.)Financial Assistance (After submitting this form please fill out the Financial Assistance Application linked on the Thank You Page.)
- You will receive a Jotform confirmation email with your child's camp choices and total cost.
- Payment is due before camp begins.
- In June, there will be an email with more LifeSports camp details.
- If you have children 4th grade or younger you will also get an electronic family pick-up pass.

CAMP WAIVER
Informed Consent and Acknowledgement I hereby give my approval for my camper’s participation in any and all activities prepared by Living Waters A/G Church during the selected camp. I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Living Waters A/G Church and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected camp sessions. In case of injury to said camper, I hereby waive all claims against Living Waters A/G Church including all coaches and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in all sports activities, including basketball. Some of these injuries include, but are not limited to, the risk of fractures, paralysis, or death.
Medical Release and Authorization As Parent and/or Guardian of the named camper, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor camper, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed. Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment and x-ray examination for the named camper. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact me in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach me. Permission is also granted to the Living Waters A/G Church and its affiliates including Directors, Coaches, and Team Parents to provide the needed emergency treatment prior to the camper’s admission to the medical facility. Release authorized on the dates and/or duration of the registered season. This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named minor camper, in my absence.
Confirmation BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
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2025 LifeSports Registration

Camp Selections

CAMP WAIVER

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