Starter’s Day Camp Registration – Lamoka Baptist Camp

General Information

Child's Name*

First Last

Child's Gender*

Male
Female

Child's Age*

Guardian's Name*

First Last

Guardian's Address*

Street Address City State ZIP Code

Guardian's Phone (emergency contact)*

(###)###-###

Guardian's Email

Which Starter's Day Camp(s) is this child attending?*

*If you child is attending multiple weeks, check all the weeks they are coming. If a week is NOT listed it means it is probably FULL, but please contact us to see if there is still room or to be placed on the waiting list.

Starter's Day Camp I (July 8-12, 2024)
Starter's Day Camp III (August 5-9, 2024)

Basic Health Information

Does this child have, or has this child had, any of the following?*

*Mark all that apply.

None of the following
Rheumatic Fever
Measles
Chicken Pox
Rubella
Concussion
Disability

How extensive is this child's disability?*

*Though we are able to handle some minor disabilities, our camp and day camp staff are not prepared to manage children with severe or certain disabilities. Please contact our office if you have further questions.

Estimated Date and severity of the concussion?

Does this camper have allergies?*

No
Yes

List this camper Allergies*

*Add more rows/allergies by clicking the "+" button to the right.

Allergy	Severity	Misc Info

Does this camper take medications they will need while they are with us?*

*Our Medical staff are unable to give any camper medicine or medications that are not in the original bottles (labeled) and accompanied by a Dr. order.

No
Yes

List this campers medications*

*Add more rows/medicines by clicking the "+" button to the right.

Medicine	Reason	Dosage	Frequency (am, pm. mealtime)

Dr. Order Uploader

*Upload any and all doctor orders here. You can send these to us later or bring them with us as well. All medicines and medications must be accompanied by a Dr order.

Drop files here or

Max. file size: 300 MB.

Insurance Information

Insurance Carrier*

Name of Insured*

Policy Number

Immunization Record

Immunization Options*

*If you do not have a copy of the immunization form to upload now, Please do so before you arrive for camp. Please upload it anytime by going to https://lamoka.com/immunizations/s. Campers that do not submit immunization records, may not be able to attend camp.

I will upload my child's immunization now.
I will upload an exemption letter now.

Upload Immunization Record or Exemption Letter*

Max. file size: 300 MB.

Permission & Signature

Hidden

Permissions and Provisions*

I, the guardian or parent, agree to the permissions and provisions above

Consent*

In case of an emergency, I understand that every effort will be made to contact the parent or guardian while providing care for my child. I understand that emergency care will not be delayed while trying to reach the parent or guardian. In the event that I cannot be reached I give permission to the physician selected by the Camp Administrator or Camp Nurse to secure treatment for, hospitalize, order injection, anesthesia or surgery for the above named child. The health history and all the other information given above is correct to the best of my knowledge. The camper named has my permission to engage in all camp activities, unless otherwise noted to Nurse or Administrator, including but not limited to, group games, climbing wall, swimming, archery, knife skills, baking, etc. This camper has my permission to ride the zip line(s) and I have read and understand the information on the Zip Line Course Rules, Risks, and Waiver Form. If I am signing this camper up for the Adventure Camp, I give my permission for the camp to take him/her on formal planned trips off campus for hiking and/or boating. I certify that my camper can attend camp and any pictures of them may be used for future promotion of the camp. I also give my permission for my child to use insect repellent and/or sunscreen as needed and as provided by the camp nurse. By checking the box below, I hereby agree that this camper will be expected to abide by the policies, procedures, rules, standards of conduct, and religious values of the Independent Baptist Camping Association. Failure to do so, may result in dismal from the campus. If a camper is dismissed, I, the parent or guardian, will be responsible to pick up the child from the camp or see that they are picked up from camp. Any further expense incurred by the camper as a result of dismissal will be fully my responsibility, including any necessary transportation expenses.

We have a NEW Morality Statement, you can read it by clicking HERE.

I agree to the above provisions and permissions

Payment

Attendance

This camper is attending ONE or less week of day camp
This camper is attending multiple weeks of day camp

How many days is your child attending*

*The cost is $55/day or $235 for all five days. Attend all five days and get 75% off your final day.

One Day ($55)
Two Days ($110)
Three Days ($165)
Four Days ($220)
ALL Five Days ($235)

How many weeks of day camp is this camper attending?

2 weeks ($470)
3 weeks ($705)

Would you like to buy this year's day camp t-shirt for $15?*

*Day Campers will receive a Day Camp Shirt when they arrive at camp each day they are with us, this shirt helps us identify and keep track of our day campers. This shirt can be purchased and kept or returned at the end of each day/week.

No thank you, we will return the shirt
Yes, we would like to keep the shirt for $15.

Do you have a coupon code?

No
Yes

Coupon

Would you like to add $7 today to cover the cost of your credit card transaction fee?

No
Yes ($7)

Total

$0.00