Summer Blast Registration

2019 Summer Blast Registration Form
A separate Registration Form and Medical Release Form must be completed for each camper.

* Indicates required field

Participant Name *

First

Last

Phone Number *

Address *

Line 1

Line 2

City

State

Zip Code

Country

School now attending *

Grade Entering 2019-2020 (select one) *

Mother's Name *

First

Last

Father's Name *

First

Last

Email address *

How did you hear about this activity? *

We give Lindell Study Center permission to use camp photos of our children in publicity materials such as our brochure and website. *

YES NO

T-Shirt Size (please pick one) *

S M L XL

Shoe Size (for craft purposes) *

PARENT/GUARDIAN STATEMENT *

I verify that I am the parent/guardian of the above-named camper.

Comment *