STUDENT REGISTRATION

September 16th - 18th, 2022 

Lake Placid at Hartford City, IN 

                   

Registration forms and $25 deposit are required by August 1, 2022 for the best registration rate. 

                   

$60 Registration (= deposit + $35) Chartered Outposts registered by August 1st 

$75 Registration (= deposit + 50) Unchartered Outposts registered by August 1st

$25 Registration (= deposit + $0) Adult Camp Staff by August 1st

$15 Late fee added to all registrations after August 1st, no patch or t-shirt will be provided

                 

CLICK BELOW FOR THE JLDA MAIL-IN REGISTRATION PACKET

JLDA 2022 Rev -.docx

Student Information

Parent/Guardian Consent

As the parent and/or legal guardian of this student, I give my permission for him to attend and participate in the Royal Ranger Indiana District JLDA.  I understand that reasonable safety precautions will be taken for my child.  I agree to not hold liable the Indiana District of the Assemblies of God, District leadership, or the local church group or leaders responsible for any accidents.  I understand that a first aid station will be set up on location, staffed by qualified personnel.  I give consent for them to provide any treatment to my child that they deem necessary.  I, furthermore, understand photos and videos of this event will be taken and give consent that any such taken of my child may be used in publications and/or for promotional purposes.

Emergency Medical Information & Release

As the parent or legal guardian of this student, a minor attending the Indiana District Royal Ranger JLDA, I do hereby give my consent for the administration of any treatment deemed necessary by qualified medical personnel.  I give my permission to the Ranger staff to secure and administer treatment, including hospitalization, for my child.  In the event that I cannot be reached in an emergency, I authorize the Ranger staff, to sign on my behalf, permitting my child to be treated and I agree to be financially responsible for such treatment.

Camp History

Please record all camps student has completed:

Trail of the Tomahawk

Trail of the Saber

2022 Camp Selection

Please select the camp you plan on attending in 2022.  In case of a cancellation, please select an alternate camp you would be willing to attend.

Entering 3rd-6th grade:

Entering 6th - 12th grade:

Future Action Camps

Registration


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