Summer Adventure Camp 2022 Registration
August 1-5, 2022
Christ Lutheran Church  Visalia

Please fill out a separate form for each child attending Summer Adventure Camp.
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Email *
Student First and Last Name *
Parent Name *
Parent Phone Number *
Address (Including City, State and Zip code) *
Grade student is entering in the fall *
What school does your student attend? *
Does your student have any dietary restrictions/allergies?
Any special medical or social issues we should be aware of?
Emergency Contact Name *
Emergency Contact Phone Number *
Students T-shirt size *
Home Church (if applicable)
Social Media Release: During Summer Adventure Camp, photos may be taken of the children and used in church slideshows and some social media. *
As their parent or legal guardian, I hereby consent for my child to attend and participate in Summer Adventure Camp activities (August 1-5, 2022). I also give consent for Christ Lutheran Church staff to seek medical treatment for my child if I am unable to be reached. I further agree to pay all medical charges for services rendered. *
By filling out this form, you agree to pay the $10 registration fee per student. Payment secures spot in the camp. Payment can be made at:  *
A copy of your responses will be emailed to the address you provided.
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