Summer 2008 Registration Form

Name  _______________________    Cabin mate request  _____________________________

Address_____________________________________________________________________

City _________________________________  State _______  Zip _______________________

Grade (07-08) _________   Gender _____   Birthday  __________  Phone __________________

Camper's email address ___________________________________________

Parent/Guardian _____________________________ Work Phone ________________________

Home Congregation ____________________________ Parent's Cell Phone __________________ 

Circle the camp you are registering for:

Camp Achieve June 5-6,9-11$15/day

Cottontail Day Camp June 12    $15

Chipmunk Day Camp June 13   $15

Third Grade June 16-18            $80

Fourth Grade June 18-21          $80

Fifth Grade June 23-28            $140      

Sixth Grade July 7-12              $140

Sr. High July 14-19                  $140

Jr. High July 27-Aug 1             $140

BWCA trip TBA                     $225

Swan Lake T-Shirts $10

T-Shirt Options

(Circle one)

      

     Youth S (6-8)

       Youth M (10-12)

       Youth L (14-16)

       Adult S (34-36)

       Adult M (38-40)

       Adult L (42-44)

       Adult XL (44-46)

       Adult XXL (50-52)

Fee Calculation

Camp Fee                                                                  ______________

 

Church Scholarship                                 - $ ____________

 

Bring a Friend who has NEVER been to SLCC     - $  ______________

(applies only to 5th - Sr. high camps only)  ($15 off)

Friend's Name ___________________________________

CD of Pictures from your week of Camp ($5) ___________

                                                       

T-shirt (circle size)                                           +$10    ______________

T-Shirt is FREE if registration is postmarked by June 1st. 

(This applies to 3rd- Sr. high Camps only.)

 

Total Due                                                                   ______________

Please include payment with your registration. Make Checks payable to:

Swan Lake Christian Camp

 

Send to:

45474  288th St

Viborg, SD 57070

 

* * If your  registration is postmarked by June 1st your SLCC t-shirt is FREE! (applies to 3rd. - Sr. High camps only)

* Bring a friend who has NEVER been to camp before and take $15 dollars off your registration fee.

*** Camp scholarships are available upon request. Call the camp for more info.

                                                                         

Health Form

Since there are no required examinations, it is important that the parent/guardian fill this form out

carefully and completely.

____________________________________________________________________________

Camper Name                                   Health and Safety Provisions

A hospital and clinic are within 5 miles of the campgrounds. Registration fees include accident

insurance for all campers. Water activities are supervised by qualified water safety personnel.

Arrangements can be made for campers requiring medications during registration. In case of

emergency call the camp at (605) 326-5690)

                                                                            Health History

Please indicate which of the following conditions the camper has/has had. Give approximate dates.

Allergies ________________________         Do you give permission for your childe to take over-

_______________________________          the counter medications if necessary? ________

Medical Conditions________________          (ie for headaches, upset stomach, cramps)

_______________________________          Swan Lake has basic First Aid supplies available.

_______________________________          Are there any activities which need to be monitored/

Special Dietary Needs _____________          avoided? _______________________________

_______________________________          Family Physician ________________________

                                                                        Phone Number __________________________

Please list any prescription or non-prescription medications your child is bringing to camp.                                                                        

Name of Medication                                Taken For                                When taken                                 

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

Does the staff need to help/remind the camper of his/her treatment? ______________

If so, what kind of assistance is needed? _____________________________________________

Please note any other conditions the staff should be aware of: ______________________________

____________________________________________________________________________

____________________________________________________________________________

IMPORTANT: Please notify the camp if this camper has been exposed to any communicable disease

during the three weeks prior to camp attendance.

 

                                        Parents/Guardians, please read, fill out and sign this form

I give permission for the camp nurse or designated            In case of emergency, I hereby give permission

staff person to provide treatment if staff deem                   to the doctor selected by Swan Lake Christian

necessary from the camp's non-prescription First              Camp to secure proper treatment (including

Aid supplies.                                                                            hospitalization and surgery) for my child.

                                                                                                    I realize that Swan Lake Christian Camp will

                                                                                                   attempt to contact me if an accident or illness

                                                                                                   occurs requiring medical treatment by a physician.

 

________________________________________________________________________________

Parent/Guardian                                                                                Date