|* = Required field|
|*Please check all camps you plan to attend:|
|*Name||*Grade in Fall '13|
|*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|
|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|
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.|
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