Luther Swimming Elite II Camp Online Registration

June 9-13 2014

* = required field

Grades 9-12 (Maximum enrollment: 50)
NOTE: Campers MUST have proof of health insurance (copy of insurance card) provided to Luther college before check-in in order to participate in our camps.
First Name*
Last Name*
Grade next fall*
School*
Gender*
Age*
Birth date*
/ /
Home address*
City*
State*
Zip code*
Home phone
Parent's cell
Camper's cell
Parent's e-mail*
Camper's e-mail
Preferred Roommate (one name only)
Adult T-shirt size*
Refund Policy: Written or e-mailed cancellation notice that is received five or more business days prior to the first day of camp will result in a full refund, less a $50 cancellation fee.
Attending as:*
Payment Amount*
Payment Method
Credit Card Type*
Credit Card Number*
Expiration Month*
Expiration Year*
Name as it appears on card*
Billing Street Address*
Billing City*
Billing State/Province*
Billing Zip/Postal Code*
Billing Country