LRCC FAMILY SUMMER CAMP 2022 REGISTRATION

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Email *

Family Name *

Congregation & City *

Home Address (Include Street Name, City and Zip) *

Email *

Main Phone *

Please List All Family Participants (Include name, gender and age) *

2022 Family Camp Date (July 1 - July 4)

Arrival/Check in for your family will be between 3:30-5pm and check out will at 11am.

PRICING FOR CABINS AT LUTHER GLEN FARM (Please choose an option) *

Option 1: 2 Nights $160 for ages 18 and up $120 for ages 5-17 (Family Max $475)

Option 2: 3 Nights $215 for ages 18 and up $180 for ages 5-17 (Family Max $675)

PRICING FOR RETREAT CENTER AT LUTHER GLEN FARM (Max to a room 4 people) (Please choose an option) *

Option 1: 2 Nights $210 for ages 18 and up $175 for ages 5-17 (Family Max $650)

Option 2: 3 Nights $259 for ages 18 and up $225 for ages 5-17 (Family Max $775)

Additional Pricing Info

*FAMILY MAX APPLIES TO PARENTS/GUARDIANS AND THEIR CHILDREN ONLY. *Children under 5 are free.

*All fees include lodging, food, activities and programming

Do any members of your family have dietary restrictions? If none, type 'none'. *

Do any of your family members have any allergies? Please let us know if the allergy is life threatening, or details on its severity. If none, type 'none'. *

Activity Release Waiver

I hereby give permission for my family to participate in the programs and all activities of Lutheran Retreats, Camps & Conferences. Programs and activities include but are not limited to hiking (easy to moderate levels), rock wall climbing (easy to moderate), archery, swimming (levels determined by swim test administered on site) and other outdoor activities that will vary based on the participants abilities. I agree LRCC will not be held responsible for accidents or personal injury arising there from. I will submit a health history form two weeks prior to camp and if necessary, documentation of a recent physical exam. I give the camp staff permission to seek medical treatment for my family in case of illness or injury. *

I give permission for my family

Required

Photo Use Waiver

Your family's photo may be taken for use in camp promotional literature this summer. Your family would only be identified as participants, not by name. You can either allow us to use photos of your family, but waive the right to inspect or approve the photo if used for such purposes, or prohibit the camp from using your family's photo. *

Yes, you may use photos of my family

No, you may not use photos of my family

Terms & Conditions

I hereby give permission for my family to participate in the programs and all activities of Lutheran Retreats, Camps & Conferences. I agree LRCC will not be held responsible for accidents or personal injury arising there from. I will submit a health history form two weeks prior to camp and, if necessary, documentation of a recent physical exam.

I have read and agree to the terms and conditions above. By signing this form I give LRCC permission to charge my account the non-refundable deposit amount due of $150 indicated on my registration form. *

Yes

Payment

How will you be paying? *Your reservation will be confirmed upon receipt of your payment. *

Credit/Debit Card

Check

Name on Card *

Card Number *

Expiration Date *

Billing Address (Include Street Name, City and Zip) *

Please select the amount being paid today *

$150

Other:

A copy of your responses will be emailed to the address you provided.

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