CAMP HOPE — Christ Lutheran Church Lake Jackson, TX

2025 Camp Hope Camper Application

Camper Name

First Name

Last Name

Gender

Male

Female

Date of Birth

YYYY

Age

Grade Completed

Weeks Attending Camp ($60 per week)

Week 1 (July 21 - 25) - $60

Weeks Attending Before and/or After Camp - $20 per week

Week 1 - Before Camp (BC) Only (July 21 - 25, 7:30 - 9:30) - $20

Week 1 - After Day (AD) Only (July 21 - 25, 3:30 - 5:30) - $20

Pizza Wednesday - $5.00 per week

Week 1 - $5

No Pizza

TALLY FEES

Total the boxes checked and enter total fees due below.

Parent #1 Name, Best Phone Number to Reach, and Email Address

Parent #2 Name, Best Phone Number to Reach, and Email Address

Guardian's Name (if applicable), Best Phone Number to Reach, and Email Address

Mailing Address

If you worship regularly, what congregation do you attend?

MEDICAL INFORMATION: Doctor's Name and Phone Number

MEDICAL INFORMATION: Insurance Company

MEDICAL INFORMATION: List any allergies

MEDICAL INFORMATION: List any medications

MEDICAL INFORMATION: Does your child need to take medication during the day? If yes, please fill out separate Medication form.

Yes - my child needs medication while at camp

No - my child does not need medication while at camp

EMERGENCY CONTACT #1: Provide name, best phone number to reach, and relationship to child.

EMERGENCY CONTACT #2: Provide name, best phone number to reach, and relationship to child.

CONSENT

The child registered on this form has my permission to participate in Camp Hope Ministries during the indicated sections. I agree that CHRIST LUTHERAN CHURCH, Camp Hope, LEAD and/or the ELCA will not be held resposible for accidents arising thereof. I am responsible for any medical obligations incurred during these camp activities and give the camp permission to seek treatment in case of injury or illness. I understand that I am ultimately responsible for my child's behavior at camp and that they will be expected to sign and live by the Camp Covenant which states "I WILL SHOW RESPECT FOR GOD, OTHERS, AND MYSELF." I know that violation of this covenant can and will result in my child being removed from the program.

SIGNATURE OF PARENT OR GUARDIAN

PUBLICITY PERMISSION

Please indicate below your permission for Christ Lutheran Church, Camp Hope Ministries, LEAD and/or the ELCA to use, publish, or disclose in newsletters, brochures, periodicals, posters, website, or other media related vehicles, any photographs, videos, audios, or other material in which my child may have appeared, spoken, written, or otherwise been represented

SIGNATURE OF PARENT OR GUARDIAN

2025 Camp Hope Camper Application

Thank You