2020 LWC Youth Camp Registration

2020 Youth Camp Registration June 15th-19th

* Indicates required field

Student's Name *

First

Last

Grade Child Will Be In Aug. 2020 *

Parent/Guardian Name *

Cell Phone Number *

Address *

City *

State *

Zip Code *

Parent/Guardian Email *

Student's Food Allergies *

Emergency Contact Name *

Emergency Contact Phone # *

Emergency Contact Relationship to Child *

Other Allergies or Medical Conditions *

May we have permission to photograph and/or video your student for use in church publications? *

Submit