Luther Swimming Elite Camp Online Registration

June 13-16, 2016

* = required field

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Grades 5-12 (Maximum enrollment: 50)
NOTE: Campers MUST have proof of health insurance (photocopy 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*
Events/Times*
Gender*
Age*
Birth date (MM/DD/YYYY)*
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)
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*
Name as it appears on card
Billing Street Address
City
State/Province
Zip/Postal Code
Country