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Heit's Point New Student Retreat

Heit's Point Student Retreat

Heit's Point Lutheran Camp

New Student Retreat

Sponsored by The Lutheran High School of Kansas City

When: August 5th - 7th, 2020

Where: 28345 Heit's Point Ave, Lincoln MO 65338

Price: $50 (includes meals and camp activities such as gym, pool, confidence course and access to the lake)

Name: 

Age: 

Gender: 

Grade at LHS: 

Parent or Guardian #1

Name: 

Address: 

Phone: 

Email: 

Parent or Guardian #2

Name: 

Address (if different from above: 

Phone: 

Email: 

Please list student's allergies, medications, special needs or any other concerns that the camp directors need to be made aware of: 

Emergency Contact (if parents can't be reached)

Name: 

Relationship to Camper: 

Phone Number: 

Insurance Information:

Insurance Provider: 

Phone Number: 

Policy Number: 

Group Number: 

Release of Liability/Assumption of Risk

The undersigned participant or parent/guardian, in consideration of participation in the program/activities indicated on this form, agrees to indemnify and hold harmless Heit's Point or The Lutheran High School of Kansas City, or its representatives, its successors, and assigns and releases the same from any and all liability for any injury or illness which may be suffered by the participant, named herein, arising out of, or in any way connected with the program or activity indicated and assumes the risk for such injury or illness. I further agree to abide by all Lutheran High School of Kansas City policies and procedures.

Parent Online Signature: 

Date: 

I understand that by checking this box constitutes a legal signature confirming that I acknowledge and warrant the truthfulness of the information provided in this document. Do you agree?

I agree: 

Payment Information

Please make check/money orders out to The Lutheran High School of Kansas City. Payment must be received before the first day of camp.



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