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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 2017 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):
Cost:  $95 per week, except Day Camp
which is $50 per week.
Please check box that
corresponds to the week
you would like to attend camp.
Day Camp  May 30-June 2 (5-2nd Grade)
Session 1
Combined Week June 4-9 (Grades 5-12) 
Session 2
Junior Week June 11-16 (Grades 6-8) 
Session 3
Primary Week June 18-23 (Grades 3-5)
Session 4
Combined Week July 2-7 (Grades 5-12)
Session 5
Senior Week   July 23-29 (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 Application - Click Here   Junior Counselor Application - Click Here

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

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