Camper Application

Camper Registration 2023

Step 1 of 9

Terms of Agreement
The above information is true to the best of my knowledge. I give permission, as a legal guardian, for the camper named above to attend Minnesota Camp (MN Camp). To the best of my knowledge, the information on the Ability Evaluation and Health Form is correct and this camper has permission to engage in all activities, except as noted by myself or a health care professional.

I understand that ALL medication brought to Minnesota Camp must be in the original prescription and cannot be pre-poured. All medication must be clearly labeled with recipient, medication, dosage, frequency, route given, prescribing physician, RX#, pharmacy info and expiration date.

If I cannot be reached in an emergency, I hereby give permission the the Health Care Professional selected by MN Camp staff to hospitalize, secure treatment, order injection, anesthesia, surgery or other medical care for this camper. I will assume all financial responsibility for any treatment.

I understand that MN Camp is unable to provide specialized behavior or diet charting for this camper. If this camper requires specialized diet foods, I must provide enough for the week.

If camper displays inappropriate behavior that causes dismissal, legal guardian or residence will be responsible for immediate transportation and its cost to return camper home; no refunds will be given. I agree to notify MN Camp and withdraw this camper if camper is exposed to a contagious disease within three weeks of camp.

Permission is given only to MN Camp to use photographs and/or multi-media images and recordings in the best interest of MN Camp.

No one will be denied attendance to MN Camp because of religion, creed, national origin, gender, age or disability.
Signature (Guardian or Camper if own guardian)*
Typed Name and Phone Number of Signer*
Date*
Month
Day
Year

Lake Geneva Christian Center
605 Birch Ave
Alexandria, MN 56308

Email| mncampstaff@gmail.com Phone| 763-464-7054

Camper Application

Camper Application

Camper Registration 2023

Step 1 of 9

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