Camp LaVida Registration 2023

Our LaVida trip is scheduled for Friday, June 23-Saturday, June 24. To register moms and girls who are currently in 1st, 2nd or 3rd grade, please complete this form. Space is provided to register more than one child. If you do not need to register more than one child, please skip the section.

Name of Child 1: Name of Child 1: First Last
Name of Child 2: Name of Child 2: First Last
PARENT/FEMALE LOVED ONE attending camp: PARENT/FEMALE LOVED ONE attending camp: First Last
HOME Phone: HOME Phone: - ### - ### ####
Cell Phone: Cell Phone: - ### - ### ####
Email:
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Grade your child is CURRENTLY in:

Grade your child is CURRENTLY in: First Grade Second Grade Third Grade
CHILD'S Birthday:
CHILD 2: Grade your child is CURRENTLY in? If you are NOT registering a second child, please skip to the next question.

CHILD 2: Grade your child is CURRENTLY in? If you are NOT registering a second child, please skip to the next question. First Grade Second Grade Third Grade
CHILD 2 BIRTHDAY? Please skip if you are not registering a second child:
Allergies or health concerns for your CHILD(REN). If you are registering 2 kids, put each child's name and any allergy. If none, please answer NONE KNOWN by each child's name.
EXAMPLE:
Susie: NONE KNOWN
Betsy: Peanuts, Bee Stings and Asthma
Allergies or health concerns for the ADULT. If none, please answer NONE KNOWN:
Adult females are REQUIRED to complete a background check provided by Camp LaVida. I understand this and I am willing to complete the form. I understand that if I fail to complete the form in a timely fashion, I will not be allowed to attend:

Adult females are REQUIRED to complete a background check provided by Camp LaVida. I understand this and I am willing to complete the form. I understand that if I fail to complete the form in a timely fashion, I will not be allowed to attend: Yes, I understand and agree to complete the background check in a timely manner.
Mrs. Michelle will not be collecting money.

Mrs. Michelle will not be collecting money. I plan to pay online. I plan to pay using the payment envelopes and putting them in the offering box or dropping them off by the office. Scholarship is needed.
I understand that when reservations are made January 30, the church has fully paid the fee. It is my responsibility to pay the church back at each scheduled payment.

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
I understand that if I change my mind or cancel for any reason other than a medical situation, I am still responsible for paying the church back for the full amount of the reservation.

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.