Catalyst Camps, a division of
Cedar Lake Ministries, is located 45 miles south of Chicago, Illinois
in Northwest Indiana, just east of US-41 in Cedar Lake, Indiana
     
 

 

Catalyst Summer Camps
     
Day Camp Registration
Price Information:

$35 per camp per day. ($30 per day if registered in advance for a full week.)

$35 non-refundable deposit per camper is required with registration.

$5 discount per camper per day for each additional sibling.
$18 per camper per half-day.
$5 per camper per day additional cost for early drop-off and/or late pick-up.
 

   
Please fill in ALL form fields to the best of your ability.
Parent/Guardian Name(s):
Address Line 1:
Address Line 2:
City:
State:
Zip Code:
Emergency Phone:
Email:
Confirm Email:
  I'd like to receive CLM e-newsletter
I am actively involved in a local church:
Yes No  
If yes, what is the name of the church:
   
Check Days Attending:
June 27-30, 2016
M Tu W Th  
         
July 4-8, 2016
M Tu W Th F
         
July 11-15, 2016
M Tu W Th F

Early drop off and late pick up are available for an additional fee of $5/day per child.

Early Drop Off (7:30-8:30am)
Late Pick Up (5:30-6:30pm)
   

Family Physician Name:
Family Physician Phone:
Camper(s) Covered by Health Insurance?:
Yes No
Health Insurance Company Name:
Policy#:
Group#:
If any of the above information (i.e. days attending, insurance, physician) is not consistent for all children registering, please note in this comment box:
   

 

Camper First Name:

M F
Camper Last Name:
   
Grade in September 2016:
Half Day:
 
Mornings
Afternoons
Birth Date (mm/dd/yyyy):
   
Allergies?:
Y N
Please List:
Medications?:
Y N
Please List:
Immunizations Current?:
Y N
   
Shirt:
Camp t-shirts guaranteed only
 if requested in advance
Adult sizes:
S M L
XL XXL  
Child sizes:
S (6-8)
M (10-12) L (14-16) XL (18-20)
   

 

   
1st Sibling First Name:
M F
Last Name:
Birth Date (mm/dd/yyyy):
Grade in September 2016:
Half Day: 
 
Mornings
Afternoons
   
Allergies?:
Y N
Please List:
Medications?:
Y N
Please List:
Immunizations Current?:
Y N
   
Shirt:
Camp t-shirts guaranteed only
 if requested in advance
Adult sizes:
S M L
XL XXL  
Child sizes:
S (6-8)
M (10-12) L (14-16) XL (18-20)
   
 
2nd Sibling First Name:
M F
Last Name:
Birth Date (mm/dd/yyyy):
Grade in September 2016:
Half Day:  
 
Mornings
Afternoons
   
Allergies?:
Y N
Please List:
Medications?:
Y N
Please List:
Immunizations Current?:
Y N
   
Shirt:
Camp t-shirts guaranteed only
 if requested in advance
Adult sizes:
S M L
XL XXL  
Child sizes:
S (6-8)
M (10-12) L (14-16) XL (18-20)
   
 
3rd Sibling First Name:
M F
Last Name:
Birth Date (mm/dd/yyyy):
Grade in September 2016:
Half Day:  
 
Mornings
Afternoons
   
Allergies?:
Y N
Please List:
Medications?:
Y N
Please List:
Immunizations Current?:
Y N
   
Shirt:
Camp t-shirts guaranteed only
 if requested in advance
Adult sizes:
S M L
XL XXL  
Child sizes:
S (6-8)
M (10-12) L (14-16) XL (18-20)
   

 

Coming with a friend?
Please list the friend(s) that each of your campers would like to be grouped with (campers are typically grouped by grade/age):
   
 
Donate a scholarship
I'd like to donate a full or partial scholarship for a camper in need.
    Amount: $
   
   
HIPAA regulations require us to have your permission before disclosing any health information you give us. If we feel any of the physical/behavioral conditions you indicated on this form would be beneficial for the camp nurse, camp staff, and/or your child’s counselor to know in order to help your child have a good week, may we disclose that information to them?
 
Yes No
   

 

REQUIRED FOR EACH MINOR:  I certify that the preceding general and health/medical information is true and accurate to the best of my knowledge. I understand that there are certain dangers inherent in the summer programs and activities at Cedar Lake Ministries (CLM and Catalyst Camps). Participation in the activities is on a voluntary basis only. I give my child permission to participate in these activities. CLM does not carry camper insurance. I give my permission to the camp to provide routine health care, administer prescribed medications, and seek emergency medical treatment including ordering x-rays or routine tests if necessary. I understand that every effort will be made to contact me prior to any treatment. In the event I cannot be reached in an emergency, I hereby give permission to the physician selected by the camp to secure and administer treatment, including hospitalization, for my child.
  Yes No
I also consent to having my child’s photograph and/or video used in future promotional literature.
  Yes No
By checking "yes," I confirm that I have read and agree to the above and understand it completely.

Name of Parent/Guardian completing this form:

 
 
 payment  -------------------------------------------------------------------------------------
Need financial assistance? Download scholarship form.
  Price Information:

$35 per camp per day. ($30 per day if registered in advance for a full week.)

$35 non-refundable deposit per camper is required with registration.

$5 discount per camper per day for each additional sibling.
$18 per camper per half-day.
$5 per camper per day additional cost for early drop-off and/or late pick-up.

 

Paying by check? Indicate here

I am registering, but will pay by mailing a check
Make check payable to Cedar Lake Ministries and send to
"Catalyst Camps - DAY CAMP", PO Box 665, Cedar Lake IN 46303
and place your name in the memo.
   

Paying by Credit Card? Fill in the information below

Credit Card Number:
Please include dashes

(e.g. 1234-5678-9000-0000)
Billing Address Zip Code:
3 or 4 Digit Security Number:
Expiration Date: / (mm/yyyy)
Amount to Charge:
Promo Code:
   

 



Note: If you do not receive a confirmation on your reservation within 5 business days after submission, please contact CLM office by calling (219) 374-5941.

 

         

 

 
 
  arrow What to bring/not to bring
  arrow A typical day at camp
  arrow Camper health & safety
     
    Looking for Overnight Camp?

 

  2016  
 
 
  Session One
June 27-30, 2016

Session Two
July 4-8, 2016

Session Three
July 11-15, 2016
 

 

 

 

 

 
  Contact Catalyst Youth Camps   Contact
Catalyst
Camps
  Catalyst Camps
13701 Lauerman Street
P.O. Box 665
Cedar Lake, IN 46303
219-374-5941
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Catalyst
Camps
   
 
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