E-Learning Registration Form

Family Account #
Camper 1
First Last
Date of Birth
MM
DD
YYYY
Gender
- Boy
- Girl
Grade (2020-2021 School Year)
Does Camper 1 have any special problems or physical limitations that we should be aware of?
Camper 2
First Last
Date of Birth
MM
DD
YYYY
Gender
- Boy
- Girl
Grade (2020-2021 School Year)
Does Camper 2 have any special problems or physical limitations that we should be aware of?
Camper 3
First Last
Date of Birth
MM
DD
YYYY
Gender
- Boy
- Girl
Grade (2020-2021 School Year)
Does Camper 3 have any special problems or physical limitations that we should be aware of?

Guardian 1
- Use same Guardian 1 information as 2020 enrollment (current families only).
Name
First Last
Relationship to camper(s)
Phone
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Guardian 2
Untitled
- Use same Guardian 2 information as 2020 enrollment (current familes only).
Name
First Last
Relationship to Camper(s)
Phone
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Emergency Contact
Name
First Last
Phone

Billing Information
Cardholder's Name
First MIddle Initial Last
Phone
- Billing address same home address
Billing Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Credit Card Number
Expiration Date
CVV2/CVC2 (Security #)
Consent*
I agree to the Assumption of Risk.
I understand that part of the camping experience involves activities and group interactions, and come with uncertainties beyond what my child may be used to dealing with. I am aware of these risks, and I am assuming them on behalf of my child. I realize that no environment is risk-free, and so I have instructed my child on the importance of abiding by the camp's rules, and my child and I both agree that he or she is familiar with these rules and will obey them.

It is agreed that any dispute of cause of action arising between the parties, wether out of this agreement or otherwise, can only be brought in a court of competent jurisdiction located in Lake County, Illinois and shall be construed in accordance with the laws of Illinois.

Guardian 1