Registration Form

Registration Form

To book a place in the camp, you must complete the form below.
Parent Name

First NameLast Name
Home Phone Number
Format: (000) 000-0000.
Mobile Number
Format: (000) 000-0000.
Email Address
example@example.com
Primary Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Child 1
Name

First NameLast Name
Gender
Birth Date

MonthDayYear
Child 2
Name

First NameLast Name
Gender
Birth Date

MonthDayYear
Child 3
Name

First NameLast Name
Gender
Birth Date

MonthDayYear
Child 4
Name

First NameLast Name
Gender
Birth Date

MonthDayYear
Please provide any medical or dietary restrictions the children may have
Emergency Contact Information
Emergency Contact Name

First NameLast Name
Emergency Contact Phone Number
Format: (000) 000-0000.
Relationship to Student
I give permission to LCC and its staff to acquire medical care in the case of an emergency for the child(ren) named above and I release LCC, its staff and representatives from all liability in the event of accident, injury or emergency. I give permission & waive compensation for photos. Enter digital Signature below:

0/300
We're excited to welcome your kids for Galaxy Summer Bible Adventure! An amazing time of fun, friends, snacks, music, crafts, Jesus & so much more. IMPORTANT INFORMATION: Drop Off time is 8:45-9am and pick up is 12-12:15pm. Please wear sunscreen and dress for outdoor sports activities. All staff & volunteers at Adventure Camp are background checked. You will receive a confirmation email ensuring your registration. UPDATE: Our payment connections are not operating, so please be prepared to pay at LCC. Click Venmo below. Suggested donation is $10/ child or $30 for a family. Please call LCC with any questions you may have @ 406.222.3144
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Summer Bible Adventure — Mon-Wed, June 29-July 1, 9am-12pm
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Contact Info

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Registration Form

Child 1

Child 2

Child 3

Child 4

Emergency Contact Information

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