Summer Camp Registration

Camp Registration Form

These forms are required for your children to attend camp.
Camper's Information
Member ID
Camper Name*
Gender*

BoyGirl
Age (During Camp)*
Date of Birth*

MonthDayYear
NOTE - Campers must attend the camp that fits their age/grade group unless approved by the Camp Director.
Entering Grade*
Church Affiliation
Camp Registering For:*
T-Shirt Size
First Time Lewtana Overnight Camper?*

YesNo
My child may be released to:*
My child may NOT be released to:

Parent/Guardian Information
Parent/Guardian 1*

First NameLast Name
Relationship to Child*
Parent/Guardian 2

First NameLast Name
Relationship to Child
E-mail*
Parent/Guardian 1 Cell Phone
Parent/Guardian 2 Cell Phone
Home Phone
Work Phone
Where would Parent/Guardian 1 like to be reached while your child is at camp?

Cell PhoneWork PhoneHome Phone
Where would Parent/Guardian 2 like to be reached while your child is at camp?

Cell PhoneWork PhoneHome Phone
Mailing Address*

Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Emergency Contact(s)

Parents cannot be listed as emergency contacts. List the name of at least one person who can be contacted in the event of an emergency or illness if you cannot be reached. Any person listed should be able to assist in contacting you. At least one person listed must be able to take responsibility for the child in case the parent/guardian cannot be contacted and should be at least 18 years of age.
Emergency Contact #1
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary Phone Number*
Secondary Phone Number
Relationship to Child*
Emergency Contact #2
Full Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary Phone Number
Secondary Phone Number
Relationship to Child

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