Sports Camp Registration

* = Required field
*Please check all camps you plan to attend:
  Boys' Basketball Junior High - June 16-19 $150
  Boys' Basketball High School - June 19-22 $150
  Girls' Basketball - June 23-26 $125
  Boys' Soccer - June 23-26 $150
  Girls' Soccer - June 26-29 $150
  Girls' Volleyball High School - July 7-10 $200
  Girls' Volleyball Junior High Session 1 - July 10-13 $200
  Girls' Volleyball Junior High Session 2 - July 14-17 $200
*Name *Grade in Fall '13
*Home Address
*City *State    *Zip
*Day Phone - - *Night Phone - -
 What church do you attend?
*What school will you attend in the Fall '13?
*Adult t-shirt size S M L XL XXL    Position
*Email Address
 Roommate Preference
 Is either parent a LCU alumni?
INSURANCE INFORMATION: Must be completed in order to attend camp. I will be covered by my personal, family accident or illness insurance.
*Name of Insurance Provider
*Policy Number

RELEASE STATEMENT: We, the undersigned parents/legal guardians of , a minor, do hereby certify that said minor is physically fit and medically capable of participating in all camp activities and has had a physical exam verifying physical fitness in the last year. We further agree to advise LCU of any changed medical condition between the time of application and the time of the camp. We further authorize the Director of LCU Sports Camp to authorize medical treatment for said minor. We agree to be responsible for all costs incurred for this treatment.

*Signature of Parent or Guardian *Date / /
Please sign the Release by typing your full name above.