Christmas Camp at Lazy W Ranch
December 20th-22nd, 2019
Campers ages 7 - 14 years old
23852 Hot Springs Canyon Rd, San Juan Capistrano CA 92675
Questions? Contact us at (949) 728-0141 or eschoettger@calpacumc.org

Register before December 1st for the price of $85 per camper.
Registrations after December 1st will be $105 per camper.
Bus transport available Friday evening from Shepherd of the Hills Mission Viejo for an additional $15 per camper.
Link to the payment portal will be provided after the completion of this registration form. REGISTRATION IS NOT COMPLETE UNTIL PAYMENT IS RECEIVED.
Camper Info *
First and Last (Please use preferred name)
Your answer
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Birthday
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Grade
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Gender
Your answer
Parent Info *
First and Last Name
Your answer
First and Last Name
Your answer
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Address: Street, City, State, Zip
Your answer
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Email
Your answer
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Phone Number
Your answer
Emergency Contact *
Emergency Contact's First and Last Name
Your answer
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Emergency Contact's Phone Number
Your answer
How did you hear about Christmas Camp? *
Attend a local United Methodist Church? Regular Lazy W Summer Camp attender? Found us online? We would like to how you found us. Whatever the way, we are happy you are here!
Your answer
Will your camper be using bus transportation? *
Camper drop of will be at Shepherd of the Hills UMC Mission Viejo between 4:30-5:00pm. The bus will leave Shepherd of the Hills at 5:30pm. If you are not using the bus transport or arriving later than 5:30, you will be responsible for driving your camper to Lazy W Ranch. Will you be using bus transportation for $15 per child (non-refundable)?
Required
Allergies/ Dietary Restrictions *
Please provide as much detail as possible, including level of seriousness.
Your answer
Epi Pen *
Does your child require an Epi Pen? If yes, please provide details about your child's anaphylaxis.
Your answer
Medications *
Please provide as much detail as possible.
Your answer
Health Condition *
Does your camper have any health conditions, treatments, or restrictions that require necessary accommodations?
If you answered yes to the previous question, please explain.
Your answer
Health Insurance *
Do you have medical insurance?
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Full name and phone number of policy holder.
Your answer
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Employer Name (if insured through company)
Your answer
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Insurance Company / Plan Name
Your answer
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Insurance Company Phone Number
Your answer
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Health Insurance Policy Number
Your answer
Over the Counter Medications *
Please check the box next to the over the counter medications you grant permission for the Lazy W Ranch Health Care Provider to give your child when determined by provider to be appropriate for your child's health and safety.
Required
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Is there anything that camp should be aware of when giving any over the counter medication to your child?
Your answer
Immunizations *
Your child must be "up to date" with all school required immunizations. Please check the box next to all immunizations that are up to date.
Required
If your child has not been fully immunized, please explain.
Your answer
Medical Waiver *
I hereby authorize pursuant to Family Code Sections 6900-6910 any staff member of Cal-Pac Camps, as agent for the undersigned to consent on behalf of said minor to medical care, including X-ray examination, anesthetic, medical or surgical diagnosis or treatment, and hospital care, under the general or special supervision of, and upon the advice of or to be rendered by camp Health Services, a physician or surgeon licensed under the provisions for the Medical Practice Act. For myself, and on behalf of said minor, I release, hold harmless and indemnify the California-Pacific Annual Conference, its Boards, officers, members, clergy, staff, agents and volunteers from any and all claims, losses, costs, obligations, and liabilities for injuries to any persons or for damages to or loss of property of any kind in any way arising out of participation of the mentioned minor, whether or not arising from any alleged active negligence, fault or legal liability of any kind of the California-Pacific Annual Conference, its Boards, officers, members, clergy, staff, agents and volunteers to the fullest extent permitted by California law. This authorization shall be effective December 20th-22nd, 2019 inclusive. A photocopy or other reproduction, including electronic agreement, of this authorization shall be considered as an original.
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Please sign using full legal name
Your answer
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Today's date
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Photo/Video Permission *
I give Cal Pac Camps permission to take photographs and / or video of my child.I grant Cal Pac Camps full rights to use the images resulting from photography/video filming at Christmas Camp, and any reproductions or adaptations of the images for fundraising, publicity or other purposes to help achieve the group’s aims.This might include (but is not limited to), the right to use them in their printed and online publicity and socialmedia.
Required
Santa? *
We would like to do our best to support your family and where your camper is at! Please check "Yes" if your camper is a believer in Santa. If not, please check "No".
Required
Other Information
Is there any additional medical or emotional information you would like to share with us about your camper so we can provide the best care for your child while they are in our care?
Your answer
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