Winter

Winter 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 __________________________ Cell Phone __________________________

Fee Calculation

Camp Fee ____$50_______

Church Scholarship - ______________

*Bring a Friend Discount ($5 off) - ____________

Friend's Name _________________________________

_________________________________

Total Due ______________

Please fill out page 2 including signature

* Bring a friend who has never been to SLCC before and take $5 off your registration price. Bring 2 friends and take $10 off!

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________________ (i.e. 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