Camp Code. This is a letter and number combination that is unique to your group. This code will be provided by the lead teacher or group leader. This is NOT a student ID number. The Camp Code will be two letters (usually the first two letters of your school), followed by the six digit date of arrival. For example, if students from Pattengill were arriving on October 8, 2023, their Camp Code would be PA100823.
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PART I: CAMPER'S INFORMATION
Camper's Last Name:
Camper's First Name:
Camper's Date of Birth (MM/DD/YYYY):
Camper's School (for 2022-23):
Camper's Grade Level (for 2022-23):
(Please Select)
Pre-Kindergarten
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
Other
Is this camper allergic to any food, medication, or insect stings?
(Please Select)
YES
NO
If YES, name the item(s) that this camper is allergic to and indicate the reaction.
Item #1: My camper is allergic to:
My camper's reaction to Item #1 is:
(Please Select)
Intolerance
Anaphylaxis (requires an EPI-Pen)
Item #2: My camper is allergic to:
My camper's reaction to Item #2 is:
(Please Select)
Intolerance
Anaphylaxis (requires an EPI-Pen)
Other allergy related information about the camper that we may need to know about:
Does this camper have medically-diagnosed asthma that requires you to send an inhaler to camp?
(Please Select)
YES
NO
If YES, does the camper need staff help to use their rescue inhaler?
(Please Select)
YES
NO
If YES, what triggers the camper's asthma?
Select all that apply to this camper's diet.
This camper eats a vegetarian diet.
This camper has a lactose intolerance.
This camper has a gluten intolerance.
Any other dietary information about this camper that we should know about:
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PART II: PARENT/GUARDIAN INFORMATION & PERMISSIONS
Parent/Guardian's Last Name:
Parent/Guardian's First Name:
Parent/Guardian's Primary Phone:
Parent/Guardian's Email:
The Lansing School District occasionally use photographs and/or video of campers for promotional purposes through broadcast, print, or social media. Please review the options and select one that best describes your wishes in regards to CAMP photo and video usage.
(required)
YES, it is alright for the Lansing School District to use CAMP photos and/or video of my camper for promotional purposes through broadcast, print, and/or social media.
NO, it is not alright for the Lansing School District to use CAMP photos and/or video of my camper for promotional purposes through broadcast, print, and/or social media.
Please initial to acknowledge that the information contained in this form is correct and accurately reflects the health status of the camper to whom it pertains.
Please initial to acknowledge that this camper has permission to participate in all camp activities.
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