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REGISTRATION INFO


PARENTAL INFORMATION

Please check this box if you have already entered the parental information on this form, and do not wish to again. Information from previous years is not stored, so the next section MUST be filled at least once.

$0.00

EMERGENCY HEALTH INFORMATION

This information must be filled out for each camper. A copy will be kept with the camp directors and with your child’s counselor in case of emergency.


INSURANCE INFO

Proof of medical insurance - please attach copy of camper's insurance card.

I (we) hereby grant permission for my (our) child(ren) named above to fully participate in the programs provided at Lankas camp. I (we) understand, agree and acknowledge that the Lithuanian-American Community of Washington State, the West Coast Latvian Education Center, and/or the respective directors, officers, employees or volunteers of these organizations, including the directors of Lankas camp, cannot assume any responsibility for an injury, incurred medical condition, damage or harm which might result during the course of any activity during Lankas camp or traveling to or from such activity, and shall not be liable for any claim or lawsuit arising out of any such injury, damage or harm.

In consideration of permitting my (our) child(ren) to participate in Lankas camp, I (we) agree that such responsibility for my (our) child(ren) will remain with me (us), as the parent(s) or guardian(s) of my (our) child(ren). Should any claim be asserted by any person as the result of the acts of my (our) child(ren) while participating in any activity during Lankas camp or traveling to or from such activity or should my (our) child(ren) assert any claim or lawsuit against Lankas camp, the Lithuanian-American Community of Washington State, the West Coast Latvian Education Center, and/or the respective directors, officers, employees and volunteers of these organizations, I (we) agree to indemnify and hold Lankas camp, the Lithuanian-American Community of Washington State, the West Coast Latvian Education Center, and the respective directors, officers, employees and volunteers of these organizations harmless from any such claim or lawsuit, including attorney’s fees and costs incurred in defense thereof.

I (we) further authorize medical treatment of my (our) child(ren), in the event of illness or injury sustained in my (our) absence while my (our) child(ren) is/are participating in the activities of Lankas camp. If I cannot be reached in case of emergency, I authorize all medical, surgical, diagnostic, and hospital procedures as may be performed or prescribed by a treating physician for my child. I agree to indemnify the aforementioned parties from any and all debts, liabilities and expenses incurred as a result of any medical treatment given to my child(ren).

I give permission for my child(ren) to leave camp for supervised hikes or outings that may require transportation by car or bus. I authorize the camp to take, use and publish photographs and videos of my child(ren) for its records or future advertising needs.

I have reviewed the “Lankas Camp Rules” and “Code of Conduct” with my child(ren). I understand that my child(ren) will be withdrawn from camp programs without refund should s/he disrespect the rules of Lankas camp, or the physical and emotional health and safety of other campers.


General Health Questions (explain any "yes" answers in space below)

Do any of the following apply to the camper?

Allergies List all known allergies, and describe reaction, severity, and management of the reaction (or write "none").

Medications Please list all medication (including nonprescription drugs) taken routinely. Bring enough medication to last the entire time at camp. Any medication brought to camp must be given to the camp director with proper labels and instructions.

Additional Information

If none of these apply, just enter "none" or "n/a" into the text field

I certify that the above information is accurate.


Code of Conduct and Hold Harmless Agreement (sign below)




HOODIE (optional)

Purchase a Lankas Hoodie here!



Billing Information

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