Registration Form 2011

							                                    Camp Lawrence
                                                                               BUSINESS ADDRESS:
                                                                               7725 Broadway, Suite C
                              CAMP ADDRESS:                                 Merrillville, Indiana 46410-4787
                                 68 E. 700 N.                                   Phone: (219) 736-8931
                           Valparaiso, Indiana 46383                             Fax: (219) 736-9457
                            Phone: (219) 462-8243                            Email: nwicyo@comcast.net
                                                                                   www.nwicyo.org




                                                       CAMP RATES

                                                       $225.00 per week

                        Camp Special: First week of camp (June 19 thru June 25): $175.00
                                (No other discount shall apply to this date.)

Note: A $30.00 discount may be applied to the following weeks if registration is postmarked by May 31, 2011.
Only one discount is allowed and applies to regular priced weeks only.

                                           June 26th    thru    July 2nd
                                           July 10th    thru    July 16th
                                           July 17th    thru    July 23rd
                                           July 24th    thru    July 30th


All registrations must be accompanied by a $100.00 deposit for each week attending (Example: $200 deposit for
two weeks, etc). Balance is due upon arrival at camp. All deposits are nonrefundable under any circumstance.

                               IMPORTANT INFORMATION FOR PARENTS:

Please Note: Camper must: (1) provide own transportation; and (2) present a physician’s health report to the Camp
Director upon arriving at camp. (Physical must not be dated older than six (6) weeks prior to date attending camp)
Failure to do so may result in your child not being accepted. Note: Physical is good for school and all CYO sports
that child may participate in for the upcoming school year. It is advised that parent/guardian keep a copy for their
records.

If applying for more than one week, camper must be picked up on Saturday at 10:00 a.m. and dropped off again on
Sunday at the time noted on their confirmation card.

(1) All campers receive a 50/50 cotton/polyester camp t-shirt free.
(2) Camp picture is available at camp for an additional charge.
(3) Canteen card available for $7.00

**Camp Lawrence is fully accredited by the American Camp Association and is operated by the Northwest Indiana
CYO. All children between the ages of 7 thru 14 are welcome regardless of creed, color or background.

**Staff includes Program Directors, Chaplin, nurse, on-site cook, certified water instructors, waterfront director and
nature, crafts and sports directors. Counselors live in the cabins with the campers to assure safety and leadership.

Camp Lawrence is located five miles north of Valparaiso at 68 East 700 North, Valparaiso, IN 46383.

For further information or directions, please visit our web site www.nwicyo.org

Send registration and payment to: Camp Lawrence, c/o NORTHWEST INDIANA CYO, 7725 Broadway, Suite C,
Merrillville, Indiana 46410
                                              REGISTRATION FORM

                             Mail to: CYO Camp Lawrence, 7725 Broadway, Suite C
                                            Merrillville, IN 46410

                                (Please complete a separate form for each child)
Child’s name:
Date of birth:                                                        Present age:
Male                               Female                             Grade in the fall:
Church affiliation:
School attending:
Parent’s name:
Address:
City:                                                                 State:                 Zip:
Home #                                                     Emergency #.
Parent’s signature
I wish to enroll my child at Camp Lawrence for the week(s) checked (please check all that apply):

                                       CAMP WEEKS AND THEMES
         CHOICE

                 1st wk
                                    June 19 thru June 25 - Hatfield & McCoy
                                    June 26 thru July 2 - Spirit Week
                                    July 10 thru July 16 – Holiday/Christmas in July Week
                                    July 17 thru July 23 – Carnival Week
                                    July 24 thru July 30 – Blast From the Past Week


(Campers staying for more than one week may not remain at the camp over the weekend.)
If possible, my child would like to camp with the following child (Must be of the same sex and approximate age.):



                                 Free Camp T-Shirt (Please check size needed.)

         Youth: Medium (10-12)                           Adult: Small (34-36)
                Large (14-16)                                   Medium (38-40)
                                                                Large (42-44)
                                                                X-Large (46)

On receipt of this registration form and the required deposit,, you will be sent the required physical form, parent
medical authorization form, income eligibility form and a list of what to bring and what not to bring to camp. All
of these forms, along with any balance due, must be brought to camp with you.