2024 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 NameName Child Goes ByDate of BirthMonthDayYearGenderBoyGirlParent / Guardian's NameEmail *Street AddressApartment, suite, etcCityState/ProvinceZIP / Postal CodePhoneEmergency Contact NameEmergency Contact Phone NumberNames of individuals authorized to pick up your childAllergiesAny medical conditions we should be aware ofChild's PhysicianPhysician Phone NumberCamp SelectionGo For The Gold Camp - June 10-13 (Ms. Tammy Marks) $150 *2 Spots Left*Cooking & Baking Camp - June 17-20 (Ms. Melanie Wall) $150Bible Explorers Camp - June 24-27 (Ms. Marcia Kirby) $150 *1 Spot Left*Let's Go Camping - July 8-11 (Ms. Jennifer Kolas & Ms. Casey England) $150Super Science Camp - July 29 - Aug 1 (Ms. Jennifer Kolas & Ms. Casey England) $150Payments can be made in person or mailed to the preschool. Checks should be made out to the camp leader.Consent *As a parent/guardian of a 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 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 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.Consent *Payment is NON-REFUNDABLE and camp weeks are NOT transferable.Register
