Camper Registration FormThis is our NEW and IMPROVED registration form, which will significantly reduce check in time when you drop off your camper at camp. INFORMATION YOU WILL NEED Housing: If you wish to be placed with a certain counselor or camper, you will need to know that in order to complete this form. Skills campers and Spiritual Emphasis campers will select housing upon arrival. Medications: If your child takes medications, you will need to enter information about that medication in order to complete this form. Immunization Record: Due to some NY State changes, all campers will need to submit or bring with them a copy of their immunization records, unless you are exempt for moral or religious reasons.Camper Name* First Last Gender*MaleFemaleAge*Address* Street Address City State / Province / Region ZIP / Postal Code Gaurdian/Parent's Name*Gaurdian/Parent's Phone*Guardian/Parent Email Emergency Contact**You must add at least one emergency contact that is different from the guardian/parent phone number, but you may add a second one by clicking on the "+" sign on the right side of the row.NameRelation to CamperPhone Number Which camp will this camper be attending?**Visit the corresponding page on our website to see when each camp is running this summer.Select a CampJunior Camp I (Ages 7-12)Teen Camp I (Ages 13-18)Junior Camp II (Ages 7-12)Fine Arts Camp (Ages 10-18)Art Camp (Ages 10-18)Adventure Camp (Ages 13-18)Culinary Camp (Ages 14-18)Strategy Camp (Ages 13-18)Teen Week II (Ages 13-18)Spiritual Emphasis CampIs this your child's first week of camp at Lamoka?YesNoFine Arts Camp InformationSelect a Fine Art's Track*BandString OrchestraDramaWhat instrument does this camper play?*Medical InformationHas/does this camper have any of the following?**Mark all that apply. Concussion or a history of concussion Live threatening condition Disability A ailment that is currently contagious A reason to see the nurse upon arrival for any other reason Rheumatic Fever Rubella None of the above Insurance Carrier**put "self pay" if this camper is without insurance.Insurance Policy NumberDoes this camper have any allergies?*YesNoCamper Allergies*Click "Add Entry" to add allergies for this camper. Name List all allergies below   Edit Delete There are no Entries. Add Entry Does this camper take any Medications or over the counter medicines?**You only need to select "yes" if this camper is bringing these medicines with him/her to camp. All medicines and medications must be in original bottles and must be accompanied by a Dr. Order.YesNoCamper Medications*Click "add entry" to add medications for this camper. Name Medications   Edit Delete There are no Entries. Add Entry Immunization Record Options*I will upload a copy of the immunization form for this camper now..I will bring a copy of this camper's immunization form to camp with me.I am not submitting this camper's immunization record for religious or moral reasons.Reason for not submitting immunization record (select one)*My child has a religious exemption from immunizations (when you bring your child to camp you must submit a signed letter from the camper's pastor, which states that the camper is exempt for religious reasons)I OBJECT to my child receiving immunizations. I understand the risks and take full responsibility for anything that happens as a result of sending my camper without the required immunizations.Immunization Record Uploader*Housing*Please select a cabin by clicking "Add Entry." If you do not have a preference, click "Add Entry," and then select 'no preference." If a cabin does not show up below then it is either full or not available. Cabin Selection Name Gender Camp J1 Girl's J1 Guy's J2 Girl's J2 Guy's T1 Girl's T1 Guy's T2 Girl's T2 Guy's   Edit Delete There are no Entries. Add Entry Signature and PermissionWho has permission to pick this camper up from camp?**If possible, please list several people and please give us the first and last name of each person, separated by commas.Permissions & Provisions*In case of an emergency, I understand that every effort will be made to contact the parent or guardian while providing care for my child. I understand that emergency care will not be delayed while trying to reach the parent or guardian. In the event that I cannot be reached I give permission to the physician selected by the Camp Administrator or Camp Nurse to secure treatment for, hospitalize, order injection, anesthesia or surgery for the above named child. The health history and all the other information given above is correct to the best of my knowledge. The camper named has my permission to engage in all camp activities, unless otherwise noted to Nurse or Administrator, including but not limited to, group games, climbing wall, swimming, archery, knife skills, baking, etc. This camper has my permission to ride the zip line(s) and I have read and understand the information on the Zip Line Course Rules, Risks, and Waiver Form. If I am signing this camper up for the Adventure Camp, I give my permission for the camp to take him/her on formal planned trips off campus for hiking and/or boating. I certify that my camper can attend camp and any pictures of them may be used for future promotion of the camp. I also give my permission for my child to use insect repellent and/or sunscreen as needed and as provided by the camp nurse. By checking the box below, I hereby agree that this camper will be expected to abide by the policies, procedures, rules, standards of conduct, and religious values of the Independent Baptist Camping Association. Failure to do so, may result in dismal from the campus. If a camper is dismissed, I, the parent or guardian, will be responsible to pick up the child from the camp or see that they are picked up from camp. Any further expense incurred by the camper as a result of dismissal will be fully my responsibility, including any necessary transportation expenses. We have a NEW Morality Statement, you can read it by clicking HERE. I, the guardian or parent, agree to the permissions and provisions above Payment OptionsPayment Options*Registration Fee ($50) [REQUIRED]Full Registration ($300)Full Registration Spiritual Emphasis Camp ($150)*You have two payment options: 1) You may pay the $50 required registration fee and the rest ($250) when you arrive OR 2) you may pay the full amount now and save some time when you check in for camp.Are you registering early (before May 1st)?**Campers that are registered before May 1st will receive a FREE T-shirt.YesNoWould you like to add this year's T-SHIRT to your order now for $12?**This will also be available for purchase in our camp Gift Shop, but if you add it here, you will receive it at a discounted price.NoYes ($12)Shirt Size (Adult Sizes)?*Select a Shirt SizeSmMedLargeX-LargeXX-LargeDo you have a coupon code?NoYesCoupon Additional Payment OptionsDo you wish to add spending money to you camper's spending account?*You do not need to add it now, but adding it now, will save you time when you drop your child off. NoYesHow much spending money would you like to add to their spending account?*Campers spend an average of $25 during a week of camp. Would you like to donate $3 to help cover the credit card fee associated with your payment?No, thank youYesTotal $0.00