Camp LYF 5/23-26

For More Info About Camp Follow the link below

https://www.laurelcc.org/news/camp-lyf-nrtz3

Registrant Name

Current Grade

Please select one option.

5th 6th 7th 8th 9th 10th 11th 12th Adult Registration

Registrant Birthday

Registrant Phone

Parent Name

Parent Phone

Parent Email

This address will receive a confirmation email

Other Emergency Contact

Payment

Student ($200) Justlead Student ($50) Adult/Counselor ($100) I would like to request a partial scholarship (Enter amount you can pay) ($) I would like to request a full scholarship (enter $0) ($) I will pay by cash/check at a later date (enter $0) ($)

Amount

Would you like to provide a full or partial scholarship for another student?

Does the registrant have any food allergies?

Does the (student) registrant have any medication for the nurse to be aware of?

Does the (student) registrant have any health concerns the camp nurse should be aware of?

Camp will include lake swimming, a zipline, a giant harnessed swing, and a rock climbing wall. Does your child have permission to do all of the above activities?

Has your insurance changed since filling out a permission to treat form?

Please select one option.

Yes (I need to fill out a new form) No I have never filled out a permission to treat form This registration is for an adult

Credit/Debit Card Number

Expiration Date/CVC

Name on Card

Card Billing Address

Description

For More Info About Camp Follow the link below

https://www.laurelcc.org/news/camp-lyf-nrtz3

Camp LYF 5/23-26

Description

Please Fix the Following