ADULT LEADERS REGISTER BELOW:

To register, please fill out the form below or if you would rather fill out a paper copy, please click the button below.

Adult's Information

Adult's Name

First Name

Last Name

T-shirt Size

Adult Unisex Sizing

Small

Medium

Large

X-Large

2XL

Roommate Request

Please list up to 3 friend requests, we will guarantee you at least one of those names

Emergency Contact & Parent/Guardian Information

Emergency Contact Name

This person would only be called if we cannot reach the parents in an emergency situation

First Name

Last Name

Emergency Contact's Phone Number

(###)

###

####

Relationship to Emergency Contact

Please also list any additional phone numbers here also

Medical Information

This information will be kept confidential but may be shared with the student's adult leader if necessary

Any Food Allergies?

Please list any information regarding diet - Camp Luther is willing to help accommodate with advanced notice

Authorization

I hereby give permission to the physician selected by the camp director to secure and administer treatment, including hospitalization. I hereby agree to be responsible for payment of all costs or expenses of any health care provided or other person who acts in reliance upon this consent and authorization for treatment. I also give permission to the medical personnel selected by the camp to administer first aid and treatment. I assume all responsibility and liability for injury to myself. I release and forever discharge the Lutheran Church-Missouri Synod, Camp Luther, Peace Church, and all of it's agents, servants, counselors, successors, directors, trustees, officers, employees and other representatives from any and all damages and causes of action either at law or in equity which I may have as a result of my participation in, attendance at, and travel to and from Peace activities.

ADULT LEADERS REGISTER BELOW:

You belong here.