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I would like to volunteer for a session of camp. If needed, I am
available for these sessions:
Name:
Camper Name
Date of Birth Grade this fall
Gender (circle one) M / F
Camper Email (Jr. High age and older)
Parent/Guardian Name
Mailing Address
City State Zip
Home Phone
Cell Phone (Name___________)
Email (Name___________)
Other Parent (if separate household) Other Parent Phone
Parent/Guardian
I am a first-time camper at LaMoine Christian Service Camp
Immersed Believer (circle one) Y / N
Member Church
Office Use Only
$
$
Ck#:
Ck#:
/
/
/
/
Faculty
Date:
Date:
No Show
Cell Phone (Name__________)
Camper Information
Register Online at www.lamoinecamp.org
Sponsor Church
st Chance (6/3-6/6) 1 Just for Girls (6/6-6/9) Junior 1 (7/8-7/13) Junior 2 (7/22-7/26)
ALL Day Camps
(6/16, 7/7, 7/28) ONLINE ONLY Overnighters 1 (6/22-6/23) Parent name_________________ Overnighters 2 (7/20-7/21)
Junior High 1 (6/24-6/29) Junior High 2 (7/15-7/20) Niners (6/17-6/22) High Teen (6/10 – 6/15)
Campers are permitted to attend a session of camp one grade above or below their grade level (Last Chance is ONLY for 19-24 year old individuals).
Registration Information
2018 CHECK-IN PROCEDURE
Just for Girls 2.0 (7/31-8/3) Last Chance (5/30-6/2)
2018 Registration & Health Form
Parent or guardian signature required.
Register Online at www.lamoinecamp.org
Medical Information
Doctor Phone
� Public Aid Recipient. Send a copy of card to camp with child.
Child is susceptible to: � Diabetes� � Asthma � Seizures � Hay Fever
Child is allergic to: � Poison Ivy � Mosquitoes � Bees � Penicillin
Allowed Medicine for Pain Relief: � Tylenol � Ibuprofen � None � Other:
Child has food allergies to: � Peanuts � Wheat/Gluten � Dairy � Other:
Please contact the camp office promptly to discuss special medical/dietary needs.
ALL MEDICINE SHOULD BE LEFT IN ORIGINAL PRESCRIPTION BOTTLE
AND WILL BE DISPENSED BY THE CAMP’S HEALTH & WELLNESS
COORDINATOR.
Other relevant health information
Last Tetanus Booster: / / (Date)
Insurance Information
LaMoine Christian Service Camp provides a co-insurance program for all
participants. This modest accident policy is secondary to the camper family
coverage for camp related accidents only. Parents should list their insurance
company and policy number below.
Health Insurance Co. Policy #
IN CASE OF EMERGENCY, I hereby give permission to the physician selected by the
Camp Management to hospitalize, secure proper treatment for, and to order
injections, anesthesia, or surgery for my child as named on this card. I understand,
however, that every effort will be made to contact me in case of such an emergency
and, if possible, before any such medical treatment is administered. I hereby release
the Camp from any responsibility other than normal supervision and care. In case of
accident, I will not hold LaMoine Christian Service Camp or its staff members,
management, or officers liable unless guilty of negligence.
I hereby give permission for my child to take part in all recreational and swimming activities.
I hereby give permission for any photos taken during camp to be used for promotional purposes.
I have read and agree to be bound by all camp policies in force.
Parent/Guardian Signature
Please send one form for each camper and session! Additional forms can be downloaded at www.lamoinecamp.org
Mail completed form to:
LaMoine Christian Service Camp 2760 E. County Rd 1600 Tennessee, IL 62374
Parent & Camper Reminders Map to LaMoine Camp
• Canteen snack cards are available for 4th grade campers and older during check-in. Canteen cards cost $10.00 (cards are transferable to other weeks/siblings).
• Missionary offerings will be taken at each camp session.
• Camp t-shirts: $10.00 - $15.00 (based on size). Other gear prices range from $5.00 - $20.00, including blankets, sunglasses, and sports packs.
• Emergency Phone Number: (217) 654-2238
• We do not accept email for campers.
• Camper mail should be addressed:
(Camper’s Name), (Camp Session), c/o LaMoine Christian Camp 2760 E. County Rd. 1600, Tennessee, IL 62374
(Please DO NOT SEND food or candy) • Camp Post Office located in the Retreat Center
Parents—Save on postage, drop off camper mail during check-in.
Visit www.lamoinecamp.org for more detailed directions. Warning: Do NOT depend on GPS for directions!
Dir
ecti
on
s
Bible
Swimsuit
Casual clothing
T-shirts
Tennis shoes
Paper & Pen
Sunscreen
Bug spray
What TO Bring:
Toiletries
Jacket
Towels
Flashlight
Money for canteen
Money for missions
Pillow
Sleeping bag/bedding
(twin size)
What NOT to Bring:
Day Campers will need a swimsuit & towel only.
Food
Media devices
Cell phones
Laptops/tablets
Roller blades/skate boards
Handheld video game devices
Tobacco, alcohol, or drugs
Firearms, knives, or any weapons.
Camp is designed for youth to spend a period of time away from their everyday routines. By doing so, campers are better able to focus on the greatness of God and His creation.
NOTE: Safety is of utmost importance. Please know that LCSC reserves the right to inspect personal property and confiscate anything deemed inappropriate.
This year, LCSC will be confiscating any
devices deemed inappropriate INCLUDING CELL PHONES!
All items will be labeled and placed in the camp vault until the end of the camp
session.
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