Camper Registration 6th - 10th Grade - LUTHERAN CAMPFORMATION

Student Information

* Indicates required field

Student Name *

First

Last

Grade (Fall 2022) *

Gender *

Student Birthdate *

Student Cell # *

T- Shirt Size *

Have you previously attended Campformation *

Yes No

Which congregation will you be attending with? *

Residential Address *

Line 1

Line 2

City

State

Zip Code

Country

Parent/Guardian Name *

First

Last

Parent/Guardian Phone Number *

Parent/Guardian Email *

Parent/Guardian Name *

First

Last

Phone Number *

Parent/ Guardian Email *

Emergency Contact Name *

First

Last

Emergency Contact Phone Number *

Health and Medical Information

Student's Primary Care Physician Name *

Student's Primary Care Physician -Phone *

Health Insurance? *

Yes No

If yes, name of Insurance Carrier *

Policy Holder *

Group Number *

Special Dietary Needs (if none, type NONE) *

Date of last Tetanus Shot *

Does your child have any activity restrictions? *

Yes No

If yes, what activity restrictions? *

Allergies

List any known allergies with the reactions (food, medications, etc.) If none, type NONE. *

Medications

Any prescription OR over-the-counter medication must be left with the Lutheran Campformation Nurse. Medicationmay only be left at camp if the medication is in the original over the counter or prescription container and has detailed written instructions for administration. Medications in a baggie or similar container will be refused.

Medical and Liabilty Release Statement

This health history is correct so far as I know. I hereby give permission to camp medical/first aid personnel or Camp Director to provide routine health care and emergency first aid; to release any records necessary for treatment or insurance purposes, and to provide or arrange necessary transportation. I understand that my insurance information will be given to any healthcare providers, but that I will ultimately be responsible for any medical charges in the case of illness or injury while my youth is participating at Lutheran Campformation. In the event I cannot be reached in an emergency, I hereby give the permission to the physician selected by the Camp Director to secure and administer treatment, including hospitalization, for the person named above. I understand that the camp health supervisor is present 24 hours a day, but a physician is not present. I agree to travel to Prescott to attend to my child and/or to transport my child home for fever, vomiting or as deemed necessary by the Camp Dean.

I understand that participation in this event is not without risk to my child because of the group nature of the event and the unpredictable behavior of any group, even when managed with the greatest amount of care. I understand that all reasonable safety precautions will be taken at all times by Lutheran Campformation. I understand the possibility of unforeseen hazards and know the inherent possibility of risk. I agree to not hold Lutheran Campformation, its leaders, employees, volunteers or your home church liable for damages, losses, diseases, negligence, or injuries, or death incurred by my youth.

Covid 19-Policy as of February 2022

This policy applies to every person attending and participating in Campformation, during the summer session from July 2-8, 2022. Staff training beginning July 2 and the camp session starting July 3, 2022.

Testing for Covid-19
All persons regardless of vaccination status, will provide a negative PCR Covid-19 test taken no more than (3) days prior to arriving at camp. Cost of the test is assumed by the person testing.

While at Camp
Any person, while attending camp, must report to the camp nurse if they experience any signs of Covid-19. The nurse will administer a Covid-19 antigen test at that point. If the antigen test is positive, the person will be required to quarantine and because of the required amount of time for quarantine, there is a good chance the infected person will be sent home.
*Campers will be quarantined until a parent or guardian picks up the camper. There will be no refund of camper fees in this circumstance.

Adults and staff counselors will need to arrange for your own transportation, should you test positive for Covid-19 and need to leave camp. You will also be required to quarantine if you are in camp and waiting for transportation to pick you up.

This is a living document and will be updated as conditions or requirements change

Phote Release Statement

Lutheran Campformation takes photos and videos throughout the week with the intent to celebrate the mission of Lutheran Campformation with an end of the week video. These pictures and videos MAY be used in social media and website promotion, but will not include any information on the individuals pictured (names, church affiliation, etc.). By submitting this form, you acknowledge this photo release statement and agree.
(Any concerns with the photo release statement can be brought to the attention of your church representative.)

Payment Information

All payments for Campformation will be handled through your home congregation. Please submit your payment to your pastor, youth director, or your church office by the deadlines that are specified by your home congregation.
All checks should be made payable to your home congregation.

Agreement - Electronic Signature

By checking YES below, you are confirming your agreement to the terms outlined above and that the information provided is complete and accurate. *

Yes

Parent/Guardian, please type your full first and last name. This serves as an electronic signature confirming your agreement to the terms outlined above and that the information provided is complete and accurate. *

Camper Registration6th - 10th Grade

Student Information​

Camper Registration
6th - 10th Grade

Student Information