Family Adventure Days Registration

First Name *

First

Last Name *

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Email *

How did you hear about this event?

Name of your church and the city and state. (Ex. Trinity Waukesha WI)

Please check ALL of the DAYS you will attend (including your arrival and departure dates) *

Including yourself, how many people 5 years old and older will be in your party? *

Enter how many people 4 and under will be attending. *

LP has reserved the entire facility for this event, but so that we may be able to plan please let us know whether you will be staying overnight, in a tent, or other camping unit, or a hotel, or not staying overnight. *

I have read and agree to the 'Guidelines and Rules'. I also give permission to photograph, videotape, and audio record myself, my child(ren) as well as those entrusted to my care and for local media to photograph and/or interview my child(ren). I also give permission to display my child(ren)’s work and photographs on the Lutheran Pioneer or Pineridge Camp websites, online channels, or social media pages. I hereby consent to the use of any photographs/video taken of myself, my child(ren) by Lutheran Pioneers, Pineridge Camp, and the media for the purpose of advertising or publicizing events, activities, facilities and programs of the Lutheran Pioneers or Pineridge Camp in newspapers, newsletters, websites, other publications, television, radio and other communications and advertising media. I hereby certify that I have taken the steps to attain such permission from the responsible party for anyone entrusted to my care for the purposes of Family Adventure Days, and hereby assume such responsibility. Use your finger or mouse to record your signature in the box. (you may also type your name) *

How are you going to pay? *

If you are human, leave this field blank.