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.