Camp Tomah Shinga Summer Camp Registration

Camper Information

Camper's First Name

Camper's Last Name

Grade Completed

Gender

Date of Birth

Camper T-shirt Size

Preference for Housing Mate (please enter only one)

How did you hear about Camp Tomah Shinga?

Does the camper have any exceptional needs?

Parent/Guardian Information

Parent/Guardian First Name

Parent/Guardian Last Name

Address

City, State, Zip

Home Phone Number

Cell Phone Number

E-mail Address

Congregation Name

Congregation City

Session Registration

First Choice Session Number

First Choice Dates

Second Choice Session Number

Second Choice Dates

Discounts and Deposit

Check the box if you qualify for the following discounts

Early Bird - $25 off a full week before 4/1Family Discount - $25 per child if more than one in the same family is attending any 2010 full week session

Deposit - (nonrefundable after 4/15/10)

$50 - Mini Session$75 - Full Week Session

Form Submission

By submitting this form my child has permission to take part in all Camp Tomah Shinga activities, and I will not hold Camp Tomah Shinga, Nebraska Lutheran Outdoor Ministries, Lutheran Outdoor Ministries Association of Kansas or its staff

responsible for accidents, claims and damages arising therefrom. I authorize Camp Tomah Shinga/NLOM/LOMAK to take such action as is deemed necessary for the care, welfare and health of my child, including the giving of consent for medical treatment.

I also give Camp Tomah Shinga/NLOM/LOMAK permission to use any photographs/video of my child taken at camp in future promotion of any program of Camp Tomah Shinga/NLOM.

Parent Initials

When you hit the submit button, your registration information will be sent to the registrar. You will then be transfered to paypal to pay your deposit. The registration will not be deemed valid until we have confirmation of your payment.

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