2008-02-26T10:57:00.000-08:00

C.L.W. Registration Online Form -- Summer Camp 2012

(print and mail to CLW, 1510 W Deep Creek Rd, Bryson City NC 28713)

(or paste into an email and send to regclw@gmail.com)

For Office Use Only

Date Received:___/___/___

Amount Enclosed: $______

Camper's Name:______________________

Guardian(s):_________________________
Relation to Camper: Father/Mother/Other___________
Church:_______________________
Are the parents or guardians serving on staff? Yes__ No__
E-mail Address:___________________________________________

Street:__________________________________________________
City:_______________________ State:_________ Zip:___________
Home Ph (____)____________ Work/Emergency (____)__________

Grade as of September 2011:_______ Male:__ Female:__ Birthday:___/___/___

Week(s) requested:
___ Teen Camp (July 8th - 20th) - Ages 12-17 - $395

___ Junior Camp 1 (July 22nd - 27th) - Ages 7-12 - $215
___ Junior Camp 2 (July 29th - August 3rd) - Ages 7-12 - $215

*A week of Family Camp is also being offered July 1st - 6th. Contact CLW for more details!

High Trek Trips - Ages 13 - 17 - $215:

___ Girls High Trek 1 (June 29th - July 6)
___ Boys High Trek 1 (June 29th - July 6)

___ Girls High Trek 2 (July 20th - July 27th)

___ Boys High Trek 2 ( July 20th - July 27th)

$__________ Deposit Enclosed $40 per week of camp ($80 deposit for Teen Camp)

Please pay deposit at the same time as emailing registration. Deposits can be pd thru Paypal on our website www.CampLivingWater.com or call us at 828-488-6012 with M.Card/Visa info

$__________ Scholarship Donation Enclosed (the cost of camp is kept affordable through many generous donations.)
Notes: The registration fee includes all outings, meals, and activities. All camps begin at 3 p.m. on Sunday afternoon. All camps end at 5 pm on Friday.

Cabin Requests: You can only request to be with one other camper. Both campers must be about the same age and must request each other in writing. Request or change cannot be made on the first day of camp.

Request to be in the same cabin with _______________.

Medical Information: Height____ Weight____ Hair____ Eyes____ Allergies_____________ Other___________

Date of last Tetanus shot ___/___/___

Insurance Co. _______________________________________

Insurance Co. addr and Ph. No. _________________________

Notes: All medications must be checked in with the nurse at registration, properly labeled and up-to-date. The nurse will administer the medications as labeled. Please make any additional comments, for nurse, counselor, or directors attention on the reverse of this form.

The Following is understood and agreed upon by the parent/guardian.

___ The parent/guardian signing below has legal custody of the child and will be responsible for fees and expenses incurred by the child.

___ Camp Living Water may obtain emergency medical treatment for your child if necessary.

___ your child has permission to participate in all camp activities, i.e. swimming, tubing, rafting, hiking, horseback riding, climbing tower.

___ Camp Living Water has your permission to take your child on supervised trips off the camp property such as hikes, camp outs, tubing trips, rafting, boating, rock climbing.

___ If your child violates any of Camp Living Water, he/she may be required to leave immediately. In such a case, the parent/ guardian agrees to pick up their child as early as possible.

Parent/Guardian Signature:____________________Date:___/___/___

IMPORTANT: If you are emailing this form to us, we will ask for your signature at registration on the first day of camp. If you are not accompanying your child to camp, please send a signed form with them.

CLW Summer Camp Registration