2025 Camp LAKE Forms
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Camper Information
Parent Name
*
First
Last
Camper's Name
*
I give permission for my child to ride his/her bike to camp and home.
No
Yes
Parent Handbook Acknowledgement
*
Yes
I agree to abide by the contents of the parent handbook.
Medical Information
Does your child have any allergies/food restrictions/physical limitations/special needs (ie. ADD/ADHD, et.) or need special assistance in order to participate?
*
Yes
No
List any medical conditions here:
Is your child taking any medication on a regular basis?
*
Yes
No
Will the staff be required to administer any medications?
*
Yes
No
I authorize staff to re-apply sunscreen to my child’s face, neck, and shoulders:
*
Yes
No
I authorize staff to re-apply bug/tick spray to my child’s arms and legs:
*
Yes
No
Contact Information
Mother’s Name
Father’s Name
Mom Address
Dad Address
Mom Cell #
Dad Cell #
Mom Work #
Dad Work #
Mom Email
Dad Email
Authorized to Pick Up Child
Other than the person completing this form, please list those who are able to pick up your child within 20 minutes of call. Children may leave only with those listed below. (Camper showing signs of COVID19; contact MUST be able to pick up your child within 20 minutes.)
Name
*
Relationship
*
Phone
*
Name
Relationship
Phone
About Your Child
Please include any information that you will believe will make you child more comfortable in the program. Include special interests, pets, fear, favorite activities, etc.