2025 LCCC Registration Form

JUNE 15-21 2025 LCCC Cisco Registration Form
CAMP DATES are JUNE 15-21, 2025. To secure your campers SWAG bag and T-shirt, you must register by May 31, 2025. Camper registration deadline is June 6, 2025. No refunds are given after May 15.
ONE REGISTRATION FORM PER CAMPER IS REQUIRED

PLEASE READ THOROUGHLY and SPELL NAMES CORRECTLY. THANK YOU.
Camper Name
FIRST Name*
LAST Name*
Middle Name*
Gender*

MaleFemale
Camper Information
Address*
City*
State*
Zip*
Home Phone*
Camper Cell Phone (If Applicable)*
PLEASE NOTE: NO CELL PHONES ARE ALLOWED DURING CAMP WEEK. We will only contact your camper via texts a few times a year to encourage he/she as they begin a new school year, etc.
Emergency Contact Name (If parent or guardian is not available)*
Emergency Number*
Emergency Number #2*
Birth Date*

MonthDayYear
Year of Graduation*
Grade COMPLETED by MAY 2025*
T-Shirt Size (Adult sizes only)*

SmallMediumLargeX-Large2XL3XL
Cabin Mate Request

Cabin mate request per camper (there is NO GUARANTEE, but we will try to accommodate as we can)
Cabin Buddy #1
Cabin Buddy #2
Parent or Legal Guardian Information
Parent/Legal Guardian*
Relation*
Work Phone*
Cell Phone*
Text Option*

YESNO
Parent /Legal Guardian 2
Relation 2
Work Phone 2
Cell Phone 2
Text Option

YESNO
Church Information
Church you attend (if none, indicate with N/A)*
Church City*
Church group you are attending with (if any)
Has the camper been baptized?*

YESNONot Sure
Email Confirmation
Parent/Guardian Email (camper confirmation will be sent to this email)*
example@example.com
Camper's Email
example@example.com
Other Information
How did you hear about LCCC?
First Time Camper?*

YesNo
Health Information

A health officer is on site at all times.
It is our policy to contact the parent or guardian as soon as possible in the event of a serious accident or injury. If the information has changed on the day of registration please see the health officer at that time. Please bring all medication in ORIGINAL CONTAINER or you will not be allowed to leave the medication or vitamins at the camp. No exceptions. All prescriptions MUST be in that campers name and the correct dosage.
Is camper free from infectious disease or conditions?*

YesNo
Are immunizations up to date?*

YesNo
Immunizations: Please check all that apply*

Diphtheria TetanusPolioSmall PoxCovid
Date of last tetanus shot if known (if you do not know, put NOT KNOWN)*
PHYSICIAN'S Name*
PHYSICIAN'S Phone Number*
Please Enter a Valid Phone Number.
Health Insurance Plan*
HEALTH INSURANCE Company Phone Number*
Please Enter a Valid Phone Number.
POLICY HOLDER Name*
POLICY #*
All fields are required below. If nothing applies, please put "NONE" in the box. Thanks.
Any activity the camper should be restricted from?*
Any physical, mental or other condition that would require special attention or medication while at camp?*
List any past medical treatment that would be helpful for us to know.*
List any allergies (ex: bees, peanuts, gluten, dairy)*
Any dietary needs we should know about?*
List all medications, both prescribed and over the counter. All medications will be turned into the health officer except rescue inhalers. Inhalers will stay with the camper as needed or be brought to them at specific times in their day. Bring all medication in original containers.*
MEDICAL RELEASE

I hereby grant permission to the director and or his designee to see and or administer appropriate medical aid to my child in the event of an emergency. I hereby grant permission to give my child over-the-counter medications such as, Tylenol, Ibuprofen & allergy medication. I hereby give permission to the medical personnel selected by the camp director to order X-rays, routine tests, or any treatment deemed necessary by a legally licensed physician; to release any records necessary for insurance purposes; and to provide or arrange necessary related transportation for my child. In the event, I cannot be reached in an emergency; I hereby give permission to the physician selected by the camp director and or his designee to secure and administer treatment, including hospitalization, for the person named above. The completed form may be photocopied for trips out of the camp.
MEDICAL RELEASE PARENT/GUARDIAN NAME*

First NameLast Name
MEDICAL RELEASE PARENT/GUARDIAN Signature *

Clear
Camper Release
Camper Release (List anyone, including parents, to whom your camper can be released)*
Be certain to enter your email address (in the EMAIL CONFIRMATION section) correctly to receive your campers full confirmation as well as to receive packing lists, medication information and more information prior to camp.
By hitting submit and putting your initials, you agree you are the parent or legal guardian of the above named camper, and are over the age of 18. In case of medical emergency or general medical care, I give consent for medical teatment for the aboved named camper by authorized personnel. The camp carries secondary insurance. I understand the above named camper will only be released to the names listed above, or an update must be presented upon check-in. I certify my child has my permission to attend camp and participate in all activites. I authorize The Lake Cisco Christian Camp to use my camper's picture, testimony, and video in any promotional material (web, print or media). My child may recieve future e-mails from the camp.
Appications MUST be signed by both parent/guardian & camper.
Signature of Parent/Guardian*

Clear
Electronic signature, please initial*
Signature of Camper*

Clear
Electronic signature, please initial*
FULL PAYMENT IS REQUIRED TO SUBMIT THIS FORM
PAYMENT INFORMATION:

Payment information is REQUIRED to complete your 2025 camp registration. Payment in FULL will be accepted in order to hold your campers spot. Your camper will receive 1 canteen card included in the registration fee worth $10 for the week. If you would like for your camper to have more than one canteen card, you may purchase extra at time of payment or on site at check-in.

NO REFUNDS WILL BE GIVEN after MAY 15.

If your payment is being made by your local church, you are required to fill out the next section and give the required information for church payment process.
CAMP FEE FOR 2025 is $275

CAMP TUITION is $275 (payment in full). This includes room, board, meals, class materials, 1 canteen card and accident insurance coverage for campers from the time they arrive until the time they leave camp facilities. Additional canteen cards can be purchased for $10 online with this form or at camp arrival/check-in.
If paying with a CREDIT or DEBIT CARD or with PayPal you will be redirected through PayPal once you click on the yellow PayPal button. THE PAYPAL OPTION IS OUR PAYMENT SERVER, however, you CAN PAY with a CREDIT CARD and not have a PayPal account. OR you can use your PAYPAL account if you have one. There is a credit card processing fee.

If you have questions about this registration form, contact us at lccampcisco@gmail.com or ciscosession@gmail.com
PAYMENT AGREEMENT:

I am paying to enroll my camper for the week of June 15-21, 2025 at Lake Cisco Christian Camp (LCCC). No refunds will be given after May 15, 2025. I understand each camper must follow all rules of the camp.
CHURCH GROUP PAYMENT INFORMATION: THIS SECTION IS ONLY FOR THOSE WITH PAYMENT BY THEIR LOCAL CONGREGATION. NOT FOR INDIVIDUAL CAMP PAYMENTS.

The next few questions are only for campers who are having their camp session paid for by their local congregation. Please only fill out this section if your church is paying for your youth groups attendance. Once all questions are completed, SKIP MY PRODUCTS and PAYMENT METHOD and CLICK ON THE BROWN SUBMIT BUTTON.
If you are with a church youth group paying with a check, you can pay multiple registration fees with one check. Please attach with your final payment a list of camper(s) name(s). If you have any questions feel free to contact us at ciscosession@gmail.com
If you are attending a congregation that is sponsoring your registration fee, please check one of the following boxes. Payment by your church will be required prior to check-in on June 15.

Whitney Church of Christ YouthBrenham Church of Christ YouthOlney Church of Christ YouthOther
Who from your congregation is the contact for payment? Please list first and last name. This may be a church secretary, youth minister, etc.
Church Contact's Phone Number
Please enter a valid phone number.
EMAIL contact information. This will be used to correspond with your congregation with final payment due, etc.
example@example.com
If "OTHER" was checked above, please tell us what congregation is responsible for your registration payment and answer all above questions.
CHURCH PAYMENTS ONLY: Once this section is complete, please CLICK ON THE BROWN SUBMIT BUTTON at the end of the form. Thank you.

INDIVIDUAL CAMPER PAYMENTS: Go to MY PRODUCTS and COMPLETE the payment process. Thank you.
My Products
prevnext( X )
Registration Fee Registration fee=$275, Paypal or Credit Card
$275.00

Additional Canteen Card ($10) Canteen Card plus online payment fee
$11.00 Quantity

Total

$0.00
Payment Methods

Choose from one of the PayPal options to make your payment.
Should be Empty:

JUNE 15-21 2025 LCCC Cisco Registration Form

CAMP DATES are JUNE 15-21, 2025. To secure your campers SWAG bag and T-shirt, you must register by May 31, 2025. Camper registration deadline is June 6, 2025. No refunds are given after May 15.

ONE REGISTRATION FORM PER CAMPER IS REQUIRED

Camper Name

Camper Information

Cabin Mate Request

Parent or Legal Guardian Information

Church Information

Email Confirmation

Other Information

Health Information

MEDICAL RELEASE

Camper Release

FULL PAYMENT IS REQUIRED TO SUBMIT THIS FORM

CAMP FEE FOR 2025 is $275

PAYMENT AGREEMENT:

CHURCH GROUP PAYMENT INFORMATION: THIS SECTION IS ONLY FOR THOSE WITH PAYMENT BY THEIR LOCAL CONGREGATION. NOT FOR INDIVIDUAL CAMP PAYMENTS.