Summer Camp 2020 Registration
Camper's First Name*
Camper's Last name*
Gender*
 Male
 Female
Age*
T-shirt Size*
In what school is the camper enrolled?*
In what grade?*
Home address*
City*
State*
Zip*
Parent/Guardian #1 First and Last Name*
Parent/Guardian #1 day phone*
Parent/Guardian #1 Cell phone number*
Parent/Guardian #1 email address*
Parent/Guardian #2 First and Last Name
Parent/Guardian #2 day phone
Parent/Guardian #2 cell phone
Parent/Guardian #2 email address
Persons other than parent/guardian(s) authorized to pick up camp. (Must present ID at time of pick-up)*
Name of emergency contact*
Relationship to camper*
Contact number*
Specify any of your child's health problems
Is your child on any medication?*
 Yes
 No
If yes, please specify
Weeks your child will be attending*
 Week 1 - June 29th
 Week 2 - July 6th
 Week 3 - July 13th
 Week 4 - July 20th
 Week 5 - July 23rd
 Week 6 - July 27th
Lunch: If you will be sending your child with a lunch and or snack, please be sure that it is clearly marked with your child's first and last name. Glass bottles/containers are not allowed.
Payments: Tuition may be paid by cash, credit, Cashapp ($lighthousebiblesummercamp), vemo (@LighthouseBible-SummerCamp) or check. Make checks payable to:
Light of the World Outreach Center
Registration:

Registration opens February 1, 2020
(Spaces are limited)
Contact Information:
Lighthouse Bible Summer Camp
410.206.1032
LighthouseBibleSummerCamp@gmail.com
Min. Leslie Thurman, Camp Director
Phone: 443-635-9073
Email: LeslieThurman1@gmail.com

Overseer Allison A. Lightner, Lighthouse CDC Executive Director
Phone: 410.206.1032
Email: PastorAllison@lotwoc.org
Electronic signature of Parent/Guardian

(I understand that the $125.00 fee is due at the time of registration)*
DROP OFF AND PICK UP TIMES Drop off time: 7:00 am - 9:00 am Pick up time: 4:00 pm (An additional $10.00 fee will be charged for 15 minutes after 4:00 pm) Extended care: 4:00 pm - 6:00 pm An additional $25.00 fee will be charged for every half-hour after 6:00 pm
Do we have your permission, in the event of an emergency and in case you are unavailable, to authorize any physician, nurse practitioner or medical personnel to examine, interview, test and if necessary, treat my child as they may deem advisable.*
 Yes
 No
Initial*
Your child's medical provider information: (Name, address and phone number)*
I hereby give permission to Lighthouse Bible Summer Camp, to photograph and/or videotape my child for educational and marketing purposes. *
 Yes
 No
I hereby state that my child is in good mental and physical health condition to participate in the activities provided by Lighthouse Bible Summer Camp, including but not limited to all aspects of outdoor play, sports activities and swimming. I am fully aware that any activity involving motion, height or athletic activity creates the possibility of serious injury. I hereby release Lighthouse Bible Summer Camp, Lighthouse CDC and Light of the World Outreach Center; its employees, staff, board of directors and trustees from liability to the above named camper occurring in the premises of Lighthouse Bible Summer Camp and Light of the World Outreach Center, including any event sponsored or sanctioned by Lighthouse Bible Summer Camp and or travel to and from such activities.

I understand that Lighthouse Bible Summer Camp, has the right to deny admittance to any camper not meeting the standards of the program as it sees fit. I also agree not to hold these parties responsible in the event that my child engages in inappropriate conduct (including, but not limited to disruptive or volatile behavior) or becomes involved in any activity or with any persons not associated with Lighthouse Bible Summer Camp, its scheduled program and that Lighthouse Bible Summer Camp, has the right to send my child home for inappropriate conduct. I further attest that the information contained in this application is correct to the best of my knowledge. In addition, I have agreed to the policy and fee statement and agree to comply. (Please initial)*


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