St Andrew Lutheran Church - St Andrew Lutheran Church

Mountain Camp

St Andrew Mountain Camp 2022
Depart: Tuesday, June 21st
Return: Saturday, June 25th
**This camp will be dependent upon registration. A minimum number of campers is needed.
Please submit all requested information.
NOTE: Health forms completed by a family physician are required for this camp.
Please include a copy of your child's health insurance card with the health form and submit the form to the St. Andrew office.

Camp Info & Pricing *
Cost per person: $300.
- $50.00 deposit with this online registration, by February 28th.
NOTE: There will be fundraising opportunities to keep costs well below the stated cost.
- Second payment for camp is due on March 15th.
- Final payment is due on May 17th.
2nd and final payments can be coordinated with the church office.
[Please make 2nd & final payment checks payable to St. Andrew with “Mountain Camp” in the memo line.]
* Camp pricing includes transportation to/from Camp Calumet in New Hampshire, 3 overnights, all meals and programs.

Camper's Name(*)

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Grade in Fall(*)

6th7th8th

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Date of Birth (mm/dd/YYYY)(*)

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My child has the following ALLERGY/ACTIVITY limitations.

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Street Address(*)

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State(*)

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City(*)

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Zip Code(*)

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Parent's Name(*)

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Parent Email

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Primary Phone(*)

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Camper's Email

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Emergency Authorization
I authorize counselors and staff from St. Andrew Lutheran Church to seek emergency medical attention for my child named above, should the need arise. (*)

I agree.

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Photo Release
I GRANT permission for St. Andrew Lutheran Church to use, and publish photos of my child(ren) on the church website, social media, and/or other publicity. (*)

I agree.

I do not agree.

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Parent/Guardian
By entering your name you are acknowledging that the information in the form is accurate, and you affirm the Emergency Authorization, and Photo Release choice made.(*)

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(*)

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Mountain Camp
Register Using PayPal - with your PayPal account, or with a credit card.
Register by Feb 28th.(*)

Deposit upon registration - 50.00

Full Mountain Camp payment - 300.00

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Registration Total

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