Camper Registration Camper Registration 2017 Register for summer 2017! Bring a friend who has never been to camp before and receive $25 off!* Early registration ends April 15. Note: If you need to pay for Kids' Camp, you do not need to fill out this entire form again. Simply go here to pay. Camp Session*KinderCamp (pre-K)1st-3rd Camp4th-6th Camp7th-9th CampCamper Name* First Last Gender*MaleFemaleDate of Birth* MM DD YYYY Age*(as of the beginning of camp session)Grade Entering*(as of fall 2017)Parent/Guardian Name First Last Parent/Guardian Cell Phone*Parent/Guardian Email* Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Church*Name, City (ie., Holton Lutheran, Holton)Synod*ELSWELST-Shirt Size*Youth SYouth MYouth LAdult SAdult MAdult LAdult XLAdult XXLFriends and BunkmatesFriend's name you are bringing(New friend who has never been to camp. Bring a friend and receive $25 off your fee. This person also needs to fill out a complete registration form) First Last BunkmateDo you have a friend who you would like to be cabin-mates with? First Last Parental ConsentParental Consent*I give permission for my child or ward to attend Camp Lor-Ray for duration of the appropriate camp session unless otherwise noted previously. In granting this permission, I assume full responsibility for any damages to person(s) or property caused by my child or ward. I further agree that in the event of behavior which would warrant dismissal of my child or ward from camp, I will arrange to have my child or ward picked up or assume responsibility for any expenses incurred in returning my child or ward to me. -I further give permission for any emergency medical and surgical treatment if there is insufficient time to contact me. I also consent to routine, non-surgical medical care. I also consent to having my child or ward transported by a designated vehicle to and from any hospital or clinic deemed necessary. -I give permission for the nurse to take pictures of any wounds the camper has upon arrival at camp and wounds that are incurred at camp. (If this consent form is signed by one of two parents or guardians, it is with authority of the other.)YesNoHigh Adventure Consent - Aquatics, Watercrafts, Fishing*I give permission for my child or ward to participate in the following High Adventure Activities. If "no," select "other" and explain what you do not give consent for.YesPhoto / Video Release*I agree to allow photographs, video, and interviews, which may be used in the promotion of Camp Lor-Ray, to be taken during the Camp session.YesNoAuthorization ReleaseMy child is given permission to leave Camp Lor- Ray with any of the listed persons at the time of camper pick-up.Name or Authorized Person #1* Car Make/Model*Vehicle which child will be picked up inName or Authorized Person #2 Car Make/ModelVehicle which child will be picked up inName or Authorized Person #3 Car Make/ModelVehicle which child will be picked up inAlternate Pick-Up TimeDate/Time which the camper is to be released if other than Friday after the closing devotion. Pick up from camp will be after skits and closing devotion which begin at approximately 7:00pm for 4th-9th grade camps; and at approximately 3:00pm for KinderCamp and the 1st-3rd Grade Camp. Parents are strongly encouraged to attend skits and closing devotion. No child may leave before the closing devotion unless agreed upon by Camp Director at least 24 hours in advance. All medication must be picked up from the nurse at the time of departure. Child may not leave until he/she has been properly checked out with the Camp Director and Nurse.PhoneThis field is for validation purposes and should be left unchanged.