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: email@example.com 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.
Pages to are hidden for
"Registration Form 2011"Please download to view full document