Camp Luther Registration Form

CAMP LUTHER 2018
Martin Luther School, 413 E Ave D, Bismarck, ND 58501 • 701-224-9070
Registration Form

Child’s Name: ________________________________________________________________________________
Age: __________________________________ Grade Entering Fall 2018: _____________________________
Child’s Name: _________________________________________________________________________________
Age: __________________________________ Grade Entering Fall 2018:____________________________
Child’s Name: _________________________________________________________________________________
Age: __________________________________ Grade Entering Fall 2018:____________________________

Address: _________________________________________________________________________________
City: ____________________________________________________________ State: ___________
Zip: ________________________
Home Telephone: _____________________E-Mail Address: ________________________________
Parent/Guardian: _____________________ Daytime/Cell Phone: _____________________________
Parent/Guardian: _____________________ Daytime/Cell Phone: ____________________________

Please complete the following schedule information.

Approximate Drop off/ Pick up times: _________________________________________________________________________________

Additional information you would like us to know about your child(ren) or your family:
__________________________________________________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________________________________________________

Camp Luther 2018 Rates & Policies

Fee:

Full-Time Camp participation (7:30-5:30) $150/per week

Registration Fees: A $60.00 Supply/Activity Fee is required for each camper upon registration

FINANCIAL POLICIES
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Returned Check: A $15.00 fee will be charged for returned checks and other failed payments.

Late Pick-up fee: A $10 fee will be charged for each 30-minute time block past 5:30 pm.

Parents and/or guardians agree to the following:

• Camp Luther will operate beginning Tuesday, May 29 and ending Friday, August 10, 2018. Camp Luther will be closed Wednesday, July 4th and Thursday, July 5th.

• Payment for weekly fee will be due on the first day of each week. Payment can be dropped off in the school office or the drop box located at the school office entrance.

• Parents are required to complete the Martin Luther School Emergency contact form. Current immunization forms must also be submitted for students not enrolled in a public or private school in the Bismarck-Mandan area.

• Children will need to bring a lunch from home. Fee includes an afternoon snack. Children should also bring a refillable water bottle, clearly labeled with their name.

• Reimbursement will be expected for any damages to property caused by your child(ren) in excess of ten dollars.

• Parent authorizes child(ren) to be transported by the Martin Luther School bus. The bus is in safe operating condition and in compliance with state and local laws. Staffing requirements will be met to assure the safety of children while being transported. No child will be left unattended in the vehicle. The children will be instructed on safe transportation conduct appropriate to their age and stage of development.

I have read, understand, and will abide by the policies of this contract.

___________________________________________________________________________

Parent/Guardian’s Signature Date

• • • • • • • • • • • • • • •
For Office Use

__________ $60.00 Supply and activity fee paid (per child)

__________ Martin Luther School Emergency contact form

__________ Current immunization