LSBC 2018: Illuminate - Senior High Camp

Address *

Address (if different from camper)

Cell Phone *

- Area Code Phone Number
Alternate Phone

- Area Code Phone Number
Emergency Contact Info
Emergency Contact Name(if parent or guardian is not avaliable) *
Emergency Number *

- Area Code Phone Number
Roommate Request

List first and second choice, not all requests are guaranteed.
Roommate #1
Roommate #2
Other Information
How did you hear about LSBC?
Are you a first time camper? *

Yes No
Camper Photo Release
I agree that photos taken at camp which may include my child can be used for publicity and on social media *

yes no
Church Information
Name of Church *

Church Address

Payment Information
Please note: LSBC will only bill churches with which we have a prior established payment arrangement. If you are unsure if your church has a payment arrangement with us, please make full payment in advance or choose "other" and we will contact you to discuss payment. All fees or partial fees being paid by parents/guardians must be paid no later than check-in day.
Method of payment *

Full payment / credit or debit in advance Full payment / check, cash or card on check-in day Partial Payment / credit or debit in advance, bill church remainder Partial Payment / check, cash or card on check-in day, bill church remainder Bill entire fee to church
Coupon code
Confirmation
Parents Email (camper confirmation will be sent by email, if left blank no confirmation will be sent)
By entering your initials and pressing submit, you agree that you are the parent or legal guardian of the above named camper, and are over the age of 18. In case of medical emergency or general medical care, you give consent for medical treatment for the above named camper by authorized personnel. You understand that the above named camper will only be released to the names listed above; an update to these names may be made at check-in. You certify that your child has my permission to attend camp and participate in all activites.
Electronic signature, please initial *
Should be Empty:

LSBC 2019: Jesus Saves - Day Camp #2