YOU ARE NOW READY TO SIGN UP FOR ONE OF THE MOST IMPACTING summers OF YOUR LIFE? HERE WE GO!

 
Camper Information
Please select which LIT program you plan to be a part of (2nd year applicants please select one of the "Terms"):
Name *
Name
Address *
Address
Phone *
Phone
Birthdate *
Birthdate
Medical Information
Doctor Phone *
Doctor Phone
Parent Name *
Parent Name
Parent Phone *
Parent Phone
Emergency Contact *
Emergency Contact
Emergency Contact Phone *
Emergency Contact Phone
List any allergies, medications, conditions or health concerns our medical officer & staff should be aware of. IF NONE, PLEASE TYPE "N/A"
List any medications you will NOT permit the nurse to administer: IF NONE, PLEASE TYPE "N/A"
LIT INFORMATION
Have you been a Camper at KLC before? *
Do you Attend Church Regularly? *
Aside from attending church, please list your involvement in your home church and/or outside church community.
Pastor/Youth Pastor Reference
Pastor's Name *
Pastor's Name
Pastor's Phone Number *
Pastor's Phone Number
What church does this reference pastor at?
Non-Related Adult Reference
Non-Related Adult's Name *
Non-Related Adult's Name
Non-Related Adult's Phone Number *
Non-Related Adult's Phone Number
I hereby authorize the Katepwa Lake Camp medical officer to provide or secure medical services as may be deemed necessary for my child's health and safety. I will be informed immediately of any medical services that are required. I release Katepwa Lake Camp and anyone connected with it from any and all liability claims resulting from accident and/or misfortune. I agree that my child's image or likeness may be used in camp activities or promotional material eg. cabin skits, calendars, websites, etc. Lastly, I agree that the camper (my child) is physically and mentally able to participate in all camp activities (unless otherwise noted in writing). ***Note: Should this not be acceptable, please contact The Katepwa Lake Camp Director in writing before camp begins.***
PAYMENT
How do you wish to pay?
Partner With Us
I would like to make a tax-deductible donation to further the KLC ministry.
PLEASE CAREFULLY CHECK OVER THE FORM ABOVE AS YOU WILL NOT BE ABLE TO GO BACK TO EDIT IT AFTER YOU CLICK SUBMIT.