CA MP HOPE MINI STRIES,
NOTES:
CA MPER REGI STRATION FOR M
Camper’s Name: _________________________ Gender: Male Female
Date of Birth: (mm/dd/yy) ___ / ___ / ____
Early
Bird
Savings
If you
register by:
May 31,
2014
Age / Grade Completed: ______ / _______
Attending Camp Hope Week (s)
Check all that apply
___ Week 1 July 7-11, 2014
___ Week 2 July 14-18, 2014
___ Week 3 July 21-25, 2014
◊
◊
Before Camp (BC) ____________
After Day (AD) ______________
PIZZA — Wednesdays Only
rate per week $75.00
Early Bird weekly rate $65.00
____________
____________
____________
Before Camp & After Day
are $20 each per week
____________
____________
Cost is $5.00 for each week
____________
__ Week 1 __ Week 2 __ Week 3
Sibling Discount
If you are registering more than one child,
you receive a $10 sibling discount for each child.
Christ Lutheran Church
86 Plantation Drive
Lake Jackson, TX 77566
979-297-2013
www.christlutheran-lj.org
Adult S M L XL
Medication: _________________________ Dose / Time: ____ / _____
(Provide to Manager in original container with medication form.) If your child takes any form
of medication regularly during school, we request that they be taken during Camp Hope as
well. Allergies or Diet Restrictions:
Attending Before Camp (BC) and/or After Day (AD)
Invite your
friends to
camp!
T-Shirt Size
(please circle one)
Child S M L
____________
Total $$ Due
____________
50% NON-REFUNDABLE Deposit
(Please attach payment to this form)
____________
Balance Due
( on the first Day of each camp week)
____________
Scholarships available by request.
Make Checks payable to … Christ Lutheran Church ………………………………………………………..
Camp Hope Ministries 2014
CA MPER REGI STRATION FOR M
PLEASE COMPLETE BOTH SIDES OF THIS FORM.
Do not leave any blanks empty—for your child’s safety
CA MP HOPE MINI STRIES, INC
Name of Parents
Home#
Mom Wk/Cell#
Dad Wk/Cell#
Mom’s email address
Dad’s email address
Mailing Address
City
State
Zip
Email Addresses / Names
Where do you worship? (Name of congregaon, if any.)
Insurance Company (if none, please indicate as n/a) Policy#
Phone
Dr.’s Name
Phone
Emergency Contact if parent cannot be reached. Please list dayme or cell numbers.
Name
Phone
Relaonship
Name
Phone
Relaonship
The child registered on this form has my permission to parcipate in Camp Hope Ministries, inc. during indicated ses‐
sions. I agree that Christ Lutheran Church, Lake Jackson, Texas, and/or the ELCA will not be held responsible for acci‐
dents arising thereof. I am responsible for any medical obligaons incurred during these camp acvies and give the
camp permission to seek treatment in case of injury or illness. I give permission for Christ Lutheran Church, Lake Jackson,
Texas, Camp Hope Ministries, inc, and or/ Camp Hope Ministries to use, publish or disclose in newsle(ers, brochures,
periodicals, posters, website or other media‐related vehicles, any photographs, videos, audios or other material in which
my child may have appeared, spoken, wri(en or otherwise been represented. I understand that I am ulmately
responsible for my child’s behavior at camp and that they will be expected to sign and live by the camp covenant which
states: “I will show respect for God, others, and myself”. I know that violaon of this covenant can and will result in my
child being removed from the program.
Parent or Guardian Signature / Date
Camp Hope Ministries 2014