2024 Confirmation Camp Sign up
Use this form to sign you (as a Chaperone), or your child up for Confirmation Camp! October 18-20th, 2024. We will leave for Camp Arcadia early afternoon on Friday (before school lets out).  We will return about dinner time on Sunday Evening.  
You will not be signed up until payment is received. Please don't hesitate as this camp fills up every year.  
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Email *
Type of applicant *
Required
Camper or Chaperone Name *
Camper or Chaperone Birthdate *
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DD
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YYYY
Camper or Chaperone Gender *
Camper Grade
Clear selection
Camper or Chaperone Street Address *
Parent Name(s) if Camper
Parent or Chaperone Phone Number *
Parent or Chaperone Email Address for important Communication *
Camper or Chaperone Health Plan Carrier *
Name of Insured *
Relationship to insured *
Insurance ID Number *
Group Number *
Family Doctor Name *
Family Doctor Phone Number *
Secondary Emergency Contact Person Name
Secondary Emergency Contact Person Relationship *
Secondary Emergency Contact Person Number *
Please list camper or chaperone Allergies
Any health concerns we should be aware of? heart conditions? Asthma? Seizures? Hearing aids? Last Tetanus? (Please indicate NA if none) *
By signing my name below, I hereby release and forever discharge St. Peter Lutheran Church, its agents and servants, successors, and assigns, directors, trustees, officers, employees, and other representatives from any and all damage and causes of action either at law or in equity that I may have as a result of my, or my child's participation in, attendance at, and travel to and from activities with St. Peter Lutheran Church. Furthermore, I do hereby expressly stipulate, and agree to indemnify and forever hold harmless St. Peter Lutheran Church, its agents and servants, successors and assigns, directors, trustees, officers, employees, and other representatives against loss from and all presented future claims, demands, or actions, in law or in equity, that may hereafter be made or brought by me or my child, by anyone on behalf of me or my child, or by anyone else on their own behalf for damages or any other legal or equitable remedy on account of any injury, illness, physical condition, inconvenience, or loss sustained by me or my child during activities with St. Peter Lutheran Church or travel to and from events.
By registering, I grant Camp Arcadia and its agents the right to use, reproduce, assign and/or distribute photographs, films, videotapes, and sound recordings of me or my child for use in materials they may create for the sole purpose of promoting Camp Arcadia.
I, the undersigned, hereby acknowledge that I have read the foregoing, understood its contents, and have signed the same as my own free act and deed.

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