Summer Camp Registration (K3 - LSD) – Part I - Camp Opportunities (Lansing) - Summer Camps - Summer Camps - Ebersole Center - Departments

Directions: Summer camp registration is a 2-part process that starts with the submission of Part I. Part I is a short registration form that provides basic contact information. Please provide responses to all required and relevant fields. Upon submitting Part I (and based on the types of camp opportunities you select) you will receive a follow-up email prompting you to complete a longer Part II. Part II is a health history form that is required by law from the State of Michigan.

Note that in order to reserve a space for your camper Parts I and II must be fully complete and submitted. Should you have any questions or concerns about the 2-part summer camp registration process please do not hesitate to contact us at 517-755-5001.

With gratitude and appreciation, Ben Botwinski (Ebersole Director)

Ebersole Summer Camp Registration - Part I

SECTION A: CAMP(S) SELECTION

Please select the summer camp(s) that you would like your camper to attend: (required) K-3: Under Construction (June 20) K-3: Planet Protectors (June 27-28) K-3: Color Me Wild (July 6-8)

SECTION B: CAMPER'S INFORMATION

Camper's Last Name:

Camper's First Name:

Camper's Middle Name/Initial:

Camper's Date of Birth (MM/DD/YYYY):

Camper's Gender:

Camper's School (for 2021-2022):

Camper's Grade Level (for 2021-2022):

Camper's Street Address:

Camper's City of Residence:

Camper's State of Residence:

Camper's Zip Code:

SECTION C: PARENT/GUARDIAN'S INFORMATION

Parent/Guardian's Last Name:

Parent/Guardian's First Name:

Relationship to the Camper:

Parent/Guardian's Primary Phone:

Parent/Guardian's Secondary Phone:

Parent/Guardian's Email Address:

Is the parent/guardian's mailing address the same as the camper's?

If NO, please provide parent/guardian's mailing address in the fields below.

Parent/Guardian's Street Address

Parent/Guardian's City of Residence:

Parent/Guardian's State of Residence:

Parent/Guardian's Zip Code:

SECTION D: CAMP CHAPERONE

Is an adult from this camper's family interested in chaperoning at camp?

Note that selecting YES, to the question above does not guarantee a spot as a chaperone. Chaperone space is limited and all chaperones must undergo a background check. Thank you in advance for your interest and understanding.

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11,500 Enrollment by 2025

85% Graduation Rate by 2025

90% Attendance by 2025