St. Luke's Camp Registration 2023
Please fill out this form and click submit.
Registration
Registration is due by June 30th. Camp fee for 2023 is $356.00. deposit of $100 is due with deposit.
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Child Name
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Child's Age
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Birth Date
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Child's Grade
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T-Shirt Size
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Allergies or Health Concerns
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Statement of Faith
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Parental Contact
Parent/Guardian Name
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Contact Email
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This address will receive a confirmation email
Contact Phone
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Emergency Contacts
Emergency Contact 1
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Phone 1
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Address
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Emergency Contact 2
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Phone 2
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Address
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Alternate Pick up
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Alternate Safe Word
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Payment
Deposit ($100.00)
Balance ($115)
Deposit ($100.00)
Balance ($115)
Amount
Consent
Signature
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Medical
Doctor's Name
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Doctors Contact #
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Allergies
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Medications
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Medical Info and Release Form
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Upload (8MB)
Credit/Debit Card Number
Expiration Date/CVC
Name on Card
Card Billing Address
AA
AB
AE
AK
AL
AP
AR
AS
AZ
BC
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
YT
Submit
Description
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