Lake Ellen Camp

Fees

Review

Finish

Please register below for Off-Site Pack & Trail -- grades 8-12 -- August 11-17, 2019. If you have questions please contact us at 906-542-3529 or office@lakeellencamp.org.

Registration for this event is Sunday, August 11 at 1 pm sharp. We plan to leave for Pine Marten Run at 3 pm.

If registering by May 1, 2019 you qualify for the Early Bird Discount. The coupon code is MAY1ST.

* Denotes a required field to fill in

First Time Camper? Clear My Answer

Yes!

Where did you hear about Lake Ellen?*

	Facebook
	Radio
	Poster

	Brochure
	Church
	Internet

	Friend
	Other Social Media
	Other

What levels have you attended at the Lazy E Ranch?

	Level 1
	Level 1+

	Level 2
	Level 2+

	Level 3
	Level 4

Camper's First Name*

Camper's Last Name*

Address*

City*

State*

Zip*

Phone (including area code)*

Emergency Contact Name*

Emergency Contact Phone*

Email*

Verify Email*

Church

Gender*

	Male
	Female

Birthday (MM/DD/YY)*

Grade in fall?*

Father's Name & Occupation*

Mother's Name & Occupation*

I would like to room with: (LIMIT 2)

Person who will pick up camper at the end of camp*

HEALTH FORM

Camper's FULL name*

Name of Physician*

Physican Phone*

Insurance Company*

Policy Number*

Allergies

Precautions to be observed

Known Communicable Diseases

Prescription Medications (Must be brought in original containers)

Non-Prescription Medications

Special Housing/Disability Needs

Are Immunizations up to date?*

	YES
	NO

Date of last Tetanus Booster (MM/DD/YYYY)

Known Diseases or Conditions

Special Dietarty Needs

Additional Comments???

Waiver Acceptance Required
Please read and sign the below waiver.

I, the undersigned, hereby give my permission to Lake Ellen Camp to call a doctor or emergency medical service and for the doctor, hospital or medical service to provide emergency and/or surgical care and to provide routine medical care for the above named child should the need arise.I give my permission for the applicant to participate in all activities as they pertain to his/her program, for the applicant to be transported in camp-owned vehicles to and from off-campus activities, and to use digital or print photos of the applicant for camp promotional purposes.Parent/Guardian Signature: (Please type your FULL name). By typing your full name you consent to the above disclosure.*

Acceptance:*
Full Name:*