Distance Running Camp - Family Discount Form

To receive the family discount, you must have two or more members from the same family attending the Luther College Distance Running Camp. This discount cannot be used in combination with the "Team Discount".

* = required field

Your browser is not running JavaScript or is too old to support our credit card payment process. Please reactivate JavaScript or try another browser. You will not be able to use this form.
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.
1. First name*
Last Name*
Grade next fall*
School*
Gender*
Age*
Birth date*
Camper's cell phone
Camper's e-mail
Preferred roommate (one name only)
Adult T-shirt Size*
Attending as*
___________________________________________________________
2. First Name*
Last Name*
Grade next fall*
School*
Gender*
Age*
Birth date*
Camper's cell phone
Camper's e-mail
Preferred roommate (one name only)
Adult T-shirt size*
Attending as*
____________________________________________________________
3. First Name
Last Name
Grade next fall
School
Gender
Age
Birth date
/ /
Camper's cell phone
Camper's e-mail
Preferred roommate (one name only)
Adult T-shirt Size
Attending as
_______________________________________________________
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.
Payment Amount*
Family address*
City*
State*
Zip code*
Home phone
Parent's cell
Parent's e-mail*

Payment Information

Name as it appears on card*
Billing Street Address*
City*
State/Province*
Zip/Postal Code*
Country*