2026 Summer Camp Registration Form Please fill out the form below to register for the week(s) of summer camp you’d like your child to attend. Child's Name *Child's Birthdate *Month *Day *Year *Gender *GirlBoyParent/Guardian's Name *Street AddressApartment, suite, etcCityState/ProvinceZIP / Postal CodeEmail Address *Home Phone NumberDaytime Phone Number *Emergency Contact NameEmergency Contact Phone NumberNames of individuals authorized to pick up your child:Allergies:Any medical conditions we should be aware of:Child's PhysicianPhysician's Phone NumberCamp(s) Registering For:Crafty Me Camp – June 1-4 – Tess Benton – $150Bible Explorers Camp – June 8-11 – Marcia Kirby – $150Dynomite Dinosaur Camp – June 15-18 – Tammy Marks – $150Space Camp – June 22-25 – Lisa Cox – $150Under the Sea Camp **2 yr olds or not potty trained** – June 22-25 – Kate Griffith – $150Vroom & Zoom Camp – June 29-July 2 – Marcia Kirby – $150Leaps & Bounds Camp – July 6-9 – Michelle Campbell – $150Let’s Go Camping – July 13-16 – Jennifer Kolas – $150Little Matey’s Pirate Camp – July 20-23 – Michelle Campbell – $150Color Me Crazy Camp **2 yr old or not potty trained** – July 20-23 – Kate Griffith – $150Super Science Camp – July 27-30 – Jennifer Kolas – $150Nature Camp – Aug 10-13 – Michelle Campbell – $150S.O.S. Camp – Aug 17-20 – Tess Benton – $150IF A CAMP YOU ARE LOOKING FOR IS NOT LISTED, THEN IT HAS EITHER ENDED OR IS FULL.Consent *As a parent/guardian of LAKE WYLIE LUTHERAN PRESCHOOL camp participant, I acknowledge there are certain risks of physical injury, and I agree to assume the full risk of any injuries, damages or loss which I or my minor child/ward may sustain associated with said camp. I agree to waive and relinquish all claims I or my minor child/ward may have as a result of participating in the Lake Wylie Lutheran Preschool SUMMER CAMP and their employees. In the event of an emergency, I authorize officials of the camp to secure from any licensed hospital, physician and/or medical personnel any treatment deemed necessary for my minor child’s/ward’s immediate care and agree that I will be responsible for payment of any kind and all medical services rendered, including transportation charges. My child/ward has no medical conditions that would prevent him or her from participating in the camp.Submit Form
