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*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Pronoun Medical Number Family Doctor Allergies/Medication Can they self administrator meds?* Yes No N/A Medical Condition/Exceptional Behaviours: Dates Attending* July 2 - July 5 (4 days) July 8 - July 12 Jul 15 - Jul 19 Jul 22 - Jul 26 Jul 29 - Aug 2 Aug 6 - Aug 9 (4 days) Aug 12 - Aug 16 Aug 19 - Aug 23 Aug 26 - Aug 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