SUMMER CAMP ONLINE REGISTRATION

Online Registration Available

Camp Fees:
- $250/Week
- Discounts
- $5 Sibling Discount
- $10 Multi-week Discount
Payment Options: (Cash, Check, or Charge) Make Checks payable to: Camp Wagner (memo: Junior Camp)

Pay onsite upon day of arrival -
Online (After you have filled out application click submit then proceed to online check out below.
Sponsorships are available. For more information contact Pastor Jason C. North @ 317-600-1080 or jnorth@lrcsda.com

We do offer an onsite snack shop. Put $5, $10, or $20 on your campers account so they will be able to purchase snacks.

FORMS: ALL FORMS MUST BE SIGNED

Please bring consent to a signed consent treat form per camper.
Download, Print, and sign Consent to Treat Form
What to bring?
Please bring a copy of your insurance card front and back or send via email (youth@lrcsda.com) or fax 1 (773) 442-0985.

DATES & TIMES: REGISTRATION BEGINS AT 1-5PM EACH SUNDAY.

PICK UP TIME IS 9AM EACH SUNDAY MORNING!

Session 1 - July 1-8
Session 2 - July 8-14

OFFSITE OUTINGS:

Offsite Activity Schedule May include:
- Session 1: Monday's-Skating, Tuesday-Air Zoo, Wednesday-Ideal Beach, Thursday-Airway Fun Center, Friday-AU Rock Climbing Wall/Swimming Pool, Sabbath-Potawatomi Zoo.
- Session 2: Monday's-Skating, Tuesday-AU Rock Climbing Wall/Swimming Pool, Wednesday-Michigan Adventure, Thursday-Annual Banquet "Ole Skool", Friday-AU Rock Climbing Wall/Swimming Pool, Sabbath-Warren Dunes
During offsite outings, you may want to give your camper some spending money.

Name of Camper *

Name of Camper

First Name

Last Name

Address *

Email *

Cell Phone #

(###)

###

####

D.O.B.

YYYY

Age as of June 30, 2018

Name of Parent/Guardian

First Name

Last Name

Emergency Contact Name *

Emergency Contact Number

(###)

###

####

Name of Camper #2 (Sibling only)

First Name

Last Name

D.O.B.

YYYY

Age as of June 30, 2018

Name of Camper #3 (Sibling only)

First Name

Last Name

D.O.B.

YYYY

Age as of June 30, 2018

Name of Camper #4 (Sibling only)

First Name

Last Name

D.O.B.

YYYY

Age as of June 30, 2018

Which week/s are you registering for? *

Week One July 1-8

Week Two July 8-15

Both

Religious Denomination *

Home Church *

Is your child covered by health insurance? *

Insurance Carrier *

Policy # *

Medications *

Simply put N/A if no medications are being taken

Allergies Food or Medicine (Please List) *

Date of last tetanus shot *

Date of last tetanus shot

YYYY

Name/Phone# of campers personal physician *

I give permission for my child to participate in all prescribed camp activities, except as noted by me or an examining physician. *

Yes

I understand my child will be sent home if their behavior jeopardizes the other participants, jeopardizes the intergrity of the program, or is not viewed as appropiate in anyway by the group leadership. *

I agree

I understand my child may be participating in camp activities that may include horseback riding, ropes courses, canoeing, archery, and skating. I understand that there may be inherent risks in these activities. *

I give me consent

If my child must return home due to illness or behavior, I will incur the cost of transporting them home or I will arrange transportation for my child within a realistic time specified by the Camp Director. *

I agree

I give my permission for my child to be photographed or videotaped and allow our group to release said pictures for publicity purposes. *

I agree

In the event that I am not able to pick up my camper, She/He my be release only to the following people: *

In case of an injury, parents or the emergency contact person will be called immediately for their decision on medical treatment. *

I read the above statement.

If parents or the emergency contact person in not available, we will use our best judgement as to what course of action to pursue and will continue to attempt contact. the camp or our organization will not be responsible for any costs incurred as a result of illness or injury. Parents should notify camp if this camper is exposed to any communicable diseases during the three weeks prior to camp attendance. *

I have read

I agree

The following are a list of activities that will be offered at Camp Wagner. Each activity will not be offered each week as to add variety and uniqueness to the Camp Wagner Experience: Swimming, Horseback, Go Carts, Canoeing, Ropes Course, Archery, Amusement Park, Nature Walks, Skating, Bowling. By placing a check in the box you are indicating that your camper may participate in all activities offered. If left unchecked please explain activity restrictions in the next section. *

Can participate in all activities

Please restrict my camper from the following

Please list Activity Restrictions

Cancellation Policy:

No Refunds