2017 Summer Camp Registration Form
Lake Wylie Lutheran Preschool
2906 Highway 160 W
Fort Mill, SC 29715
Danielle Hawkins, Director
803-548-5489



 
Your Email:
 *
Child's Name:
 *
Age:
 *
I want my child to attend:
 
T-Shirt Size for Music Camp ONLY
 
Parent/Guardian Name:
 *
Home Phone Number:
 
Address:
 
Daytime Phone Number:
 *
Emergency Contact Name:
 
Emergency Contact Phone Number:
 
Allergies:
 
Allergic to
 
List medical condition
 
Any medical condition we should be aware of:
 
Physician name
 
Physician Phone Number:
 
Individuals authorized to pick up your child:
 
Parent Signature:
 *
Date:
 
As a parent/guardian of a Lake Wylie Preschool camp participant, I acknowledge there are certain risks of physical injury, and I agree to assume the full risk of any injuries, damages or loss which I or my minor child/ward may sustain associated with said camp. I agree to waive and relinquish all claims I or my minor child/ward may have as a result of participating in the Lake Wylie Preschool Summer Camp and their employees.
In the event of an emergency, I authorize officials of the camp to secure from any licensed hospital, physician and/or medical personnel any treatment deemed necessary for my minor childs/wards immediate care and agree that I will be responsible for payment of any and all medical services rendered, including transportation charges. My child/ward has no medical conditions that would prevent him or her from participating in the camp.
Verification Code:
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 * Required


Copyright © 2017  Lake Wylie Lutheran Church • Fort Mill, SC • (803) 548-5489