Camp Registration Parent or GuardianParent/Guardian Name* First Last Address* Street Address City Postal Code Phone*Email* Relationship to child* Emergency Contact 1Name* Contact Number*Relationship* Emergency Contact 2Name* Contact Number*Relationship* Child AttendingChild Name* First Last Name Goes By Birthdate*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Pronoun Medical Number Family Doctor Allergies/Medication Can they self administrator meds?* Yes No N/A Medical Condition/Exceptional Behaviours: Registration Options Register for an entire week Register for individual days Pay by the weekChoose which weeks you are registering for Jul 2 - Jul 4 (3 days) Jul 7 - Jul 11 Jul 14 - Jul 18 Jul 21 - Jul 25 Jul 28 - Aug 1 Aug 5 - Aug 8 (4 days) Aug 11 - Aug 15 Aug 18 - Aug 22 Aug 25 - Aug 29 Pay by the dayChoose which days you are registering for July 2 July 3 July 4 July 7 July 8 July 9 July 10 July 11 July 14 July 15 July 16 July 17 July 18 July 21 July 22 July 23 July 24 July 25 July 28 July 29 July 30 July 31 August 1 August 5 August 6 August 7 August 8 August 11 August 12 August 13 August 14 August 15 August 18 August 19 August 20 August 21 August 22 August 25 August 26 August 27 August 28 August 29 August 19 August 20 August 21 August 22 August 23 August 26 August 27 August 28 August 29 August 30 Email Newsletter Sign up to receive email news about upcoming LRCC events and programs Registration CostTotal $ 0.00 CAD Payment Method*Your spot won't be guaranteed until full payment has been received. I'll pay online now using my credit card I'll pay cash or cheque at the LRCC Credit Card Cardholder Name Card Details