Milwaukee Lutheran High School Summer Programs Registration
Please return this form with a check payable to: Milwaukee Lutheran High School Association and mail to:
Milwaukee Lutheran High School
9700 West Grantosa Drive
Milwaukee, Wi. 53222
414-461-6000
STUDENT: _____________________________________________________________
ADDRESS: _____________________________________________________________
CITY: _________________________________________________________________
ZIP: ______________________
EMAIL: _______________________________________________________________
PHONE: _______________________________________________________________
EMERGENCY PHONE: ____________________________________________________
PARENTS NAME: _______________________________________________________
SCHOOL YOU ATTEND: __________________________________________________
GRADE 2008-2009 SCHOOL YEAR: __________________________________________
T-SHIRT SIZE (circle/all tshirts are adult sizes): XS S M L XL
Indicate below the program each student will be attending. Please list class number or time if appropriate.
PROGRAM/CLASS/CAMP COST
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
FAMILY DISCOUNT: $5.00 may be deducted from the cosst of each program if: 1. an individual enrolls in 3
or more programs or 2. members of a family enroll in 3 or more programs. BAND CAMP EXCLUDED.
TOTAL COST:$_____________________
LESS DISCOUNT:$__________________
AMOUNT PAID:$____________________
CHECK NUMBER:____________________
Release and Affirmation:
We hereby affirm that we are aware of the inherent risks and hazards of the program enrolled in and by signing this release certify that we are cognizant of those risks. We understand and agree that neither the Lutheran High School Association nor any of its employees and agents may be held liable in any way for any occurrence, including rescue operations, in connection with the class/camp which may result in injury, death or other damages to me or my family, heirs, or assigns, and in consideration of being allowed to participate in this camp, we hereby personally assume all risks in connection with said camp and activities related thereto for any harm, injury, or damage which my befall me and further to save and hold harmless the program, Lutheran High School Association, and all persons associated therewith from any claim by us, or our families, estates, heirs, or assigns arising out of enrollment and participation in this course.
This is signed by the camp participant and his or her legal guardian and parents with their consent. We understand that the terms herein are contractual and not a mere recital, and that this has been signed freely and voluntarily. It is the intent of the signers hereto to exempt and release the Lutheran High School Association and all of its agents and derivative damage caused by anyone's act, error, omission or negligence.
We have fully informed ourselves of the contents of this Release and Affirmation by reading and understanding it before we signed it.
MOTHER:______________________________________________________________________
FATHER:_______________________________________________________________________
LEGAL GUARDIAN:______________________________________________________________
STUDENT:_____________________________________________________________________