Camp Registration Form

Name of camp:

Date of camp:

Campers name:

Date of birth:

Female:

Male:

T-Shirt Size: Select... Youth Small Youth Medium Youth Large Adult Small Adult Medium Adult Large Adult Xtra Large Adult 2Xtra Large

Contact name:

Phone:

Relationship:

Contact name:

Phone:

Relationship:

Name:

Address:

 

City:

State:

Zip:

Email:

Phone:

Fax:

Congregation/
City:

I consent to the use of any photography and video of my child in future Lutheran Outdoor Ministries Camp publication.
I Consent

Parent/Guardian Authorizations: The person herein described has permission to engage in all camp activities except as noted.

I waive any and all claims for personal injury or property damage that may occur as a result of my child's participation in the following activities while attending LOMF programming:

At Luther Springs:
Swimming, Outdoor Games, Archery, Boating, Lake Canoeing, River Canoeing, Hiking, Challenge Course (low ropes), Overnight Tent Camping, Cookouts, Nature Trails

At off-site camp programs:
Kayaking Trip, Off-Site Trips, Snorkeling Trip, Service Projects, Trolley Tour Surfing, Surf Instruction

At leadership programs:
Weekend Activities & Transportation, Day Camp Leadership, Host Home Stay Day Camp Transportation

In consideration for my child's participation in above noted activities, I hereby grant to Lutheran Outdoor Ministries of Florida (LOMF), the Florida-Bahamas Synod of the Evangelical Church in America, and the Evangelical Lutheran Church in America and their agents a release of all legal and equitable claims, actions, or suits that may arise as a result of the above named camper's participation in planned program activities.

This release is to be read broadly to include transportation to and from planned program activities and transportation while involved in planned program activities.

I Authorize Permission

The camper also understands and agrees to abide by any restrictions placed on his/her participation in camp activities.
I Agree to restrictions

Is the participant covered by family medical/hospital insurance?
Yes No

If so, indicate carrier or plan name:

Group #: