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Applications

LPBC Camper Application

Prior to completing the application below, please carefully review the following statements:

LPBC Emergency Medical Treatment Statement

The camper described in the application submitted below has my permission to attend camp and to participate in swimming and all other activities. I understand that in case of serious injury or illness, I will be notified; but if I cannot be contacted, permission is given for emergency treatment of surgery as recommended by the attending physician. In case of emergency, campers will be taken to Phelps County Regional Medical Center.

LPBC Covenant Agreement

I understand that the rules and codes of LPBC are necessary for the Christian atmosphere of the camp. I have read the application and will do all I can to obey these rules, including the dress code, and to be a Christ-like example to all campers and staff.

Counselor Application - Click here Junior Counselor Application - Click here

LPBC 2012 Online Application For Campers

Please fill out this application completely.

Camper's Name: *
Gender:
Birthday: *
Age: *
Address: *
City: *
State:
Zip: *
Parent or Guardian Name: *
Telephone Number: *
Email Address: *
Church Preference: *
Home Congregation: *
Baptized?:
Have you attended LPBC Before?:
Choose T-Shirt Size (Included in camp fee):
	Please check box that corresponds to the week you would like to attend camp.
Primary Week June 3-8 (Grades 3-5)	Session 1
Junior Week June 10-15 (Grades 6-8)	Session 2
Combined Week June 17-22	Session 3
Day Camp June 25-June 28 1 (5 - 2nd grade)	Session 4
Combined Week July 22-27	Session 5
Senior Week July 29-Aug 3 (Grades 9-12)	Session 6
	Please check the corresponding box for any conditions that apply to you.
	Allergies
	Asthma
	Convulsions
	Diabetes
	Heart Condition
Medications:
Date of last Tetnus shot:
Insurance Company:
Policy Number:
Other Important Medical Instructions:
I have read and understand the LPBC Emergency Medical Treatment Statement and the LPBC Covenant Agreement. I will abide by the terms and guidelines stated in both statements.	I Agree
Parent or Guardian Initials: *

Counselor Personal Info Form 2012 Junior Counselor Personal Info Form 2012

Print this form and mail to this address: P.O.Box 251Rolla, Missouri 65402

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