Camp Lutherhaven, Indiana 2008 Summer Registration Form
(One registration per camp program)

  1. Complete either the "Register Camper" section or "Register Family" section below.

  2. Fill out the "Complete Contact Information" section.

  3. Make payment and mail to Camp.

Register Camper
 (For all children/youth programs)
Last name:
First name:
Current grade ('07/'08):
Birthdate: ( _ _/_ _/_ _ )
Sex: M F
Parent(s)/guardian(s):
Program name:   1st choice)
                 Alternate choice)
Roommate preferences: 1st)
                                         2nd)
Counselor preference:
 continue below at complete contact information

-OR-

Register Family
 (For Family, Father/Son, Mother/Daughter, and Kindercamp)
Participants' names (first & last)

M or F

 Birthdates ( _ _/_ _/_ _ )
MF
MF
MF
MF
MF
MF
Camp program desired:
Housing preferences: 1st)
                                      2nd)
Roommate preference (for F/S or M/D):

 

Complete Contact Information

  

Make Payment
Address:   Check #:
City:   Total enclosed: deposit or full payment.
State:              -OR-  
Zip:   Credit card: Visa     MasterCard
Phone:  

If you enter credit card information below, it is only used for printing your copy, It is not sent or stored electronically.
E-mail:   Amount to be charged:
Comments:   Card number:
  Expiration date:
  Name on card:
  Cardholder's signature: _______________________
Would you be willing to receive confirmation materials via email?
Yes  No		  

Check here to request financial aid.
 For Financial Aid Information - click here
Home church:   * Please mail registration form and payment to:
Church city/State:   Camp Lutherhaven
1596 S. 150 W.
Albion, IN 46701