Day Camp Registration

Registrations forms due June 18th, suggested donation of $30 for 1st-5th, $25 for Preschool, Kindergarten
A bag lunch is needed every day – dress for weather. We will remain on site at CLLC for morning hours then there will be afternoon off site activities each day.

Schedule: Monday June 26 – Thursday June 29
9am – 11:30am for Kids who are Preschool Age: 3 year old (and potty trained) thru entering Kindergarten in the fall of 2017
9am – 3pm for Kids WHO WILL BE ENTERING 1st thru 6th grade in the fall of 2017

Thursday, June 29th - 6:30pm Program and Ice Cream Social, followed by Lock-in for 4th - 6th graders.

Please either mail your payment to: CLLC, Attn: Stacy Johnson, P.O. Box 175, Center City, MN 55012, or bring your payment to the potluck or first day of Day Camp.

Questions? Contact Stacy Johnson at 651-257-6300 or cllcchrised@frontier.net

Email address
Parent/Guardian Name
Your answer
Home Address:
Your answer
Cell Phone #
Your answer
Child's Name:
Your answer
Age (children must have turned 3 by September 2017 and must be potty trained):
Your answer
Grade in Fall of 2017:
Your answer
Child's Name (if multiple children):
Your answer
Age (children must have turned 3 by September 2017 and must be potty trained):
Your answer
Grade in Fall of 2017:
Your answer
Child's Name (if multiple children):
Your answer
Age (children must have turned 3 by September 2017 and must be potty trained):
Your answer
Grade in Fall of 2017:
Your answer
Child's Name (if multiple children):
Your answer
Age (children must have turned 3 by September 2017 and must be potty trained):
Your answer
Grade in Fall of 2017:
Your answer
Who is authorized to pick up your child
Your answer
Emergency Contact, Name:
Your answer
Relationship to Child/ren:
Your answer
Emergency Contact, Cell phone:
Your answer
Any physical conditions requiring special care? please explain.
Your answer
Allergies or Special Concerns (please describe reaction and treatment)
Your answer
Any activity restrictions?
Your answer
Home Church:
Your answer
Grades 4-6: Will your child be attending the Thursday evening Lock-in?
May we have permission to photograph your child?
Would you be willing to provide extra cold lunches for the counselors? (3 lunches on one day)
Would you be willing to host the 3 counselors for Supper (Mon-Th.)
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