Summer Camp Registration
Registrations accepted online, at the LWSRA office or by mail (Send forms and payment to LWSRA, 1900 Heather Glen Dr., New Lenox, IL 60451).
PARTICIPANTS MUST HAVE A 2017 ANNUAL INFORMATION FORM ON FILE WITH LWSRA. ALL FORMS CAN BE FOUND ONLINE AT LWSRA.ORG/FORMS.
Participant’s name: ________________________________________________________
Age: _______________
Birth date:________/________/__________
This form is being filled out by: ____________________________________ Telephone:__________________________ Park District: ______________________
Billing Address:________________________________________________________ City, State: __________________________________ Zip:__________________
Ages 3-7
Code: 28060*(1-A, 1-B, etc.)
Afternoon sessions run Monday-Thursday
No camp July 4th
Week (dates)
Afternoon and
Friday options
X
LWSRA
Residents
X
Resident only
Transportation
X
SSSRA &
Non-Residents
Ages 15-21
Runs Monday-Friday 9am-3pm
No camp July 4th
Out of high school? See TITANS on page 15
Week (dates)
X
LWSRA
Residents
Resident only
Transportation
X
X
SSSRA &
Non-Residents
*1-B (6/12-6/15)
Afternoon Only (12p-3p)
$105
$32 (drop-off)
$131
280801 (6/12-6/16)
$187
$80 (both ways)
$234
*1-C (6/16)
Friday Fun Days (9a-3p)
$58
$16 (both ways)
$73
280802 (6/19-6/23)
$187
$80 (both ways)
$234
*2-B (6/19-6/22)
Afternoon Only (12p-3p)
$105
$32 (drop-off)
$131
280803 (6/26-6/30)
$187
$80 (both ways)
$234
*2-C (6/23)
Friday Fun Days (9a-3p)
$58
$16 (both ways)
$73
280804 (7/3-7/7)
$150
$64 (both ways)
$188
*3-B (6/26-6/29)
Afternoon Only (12p-3p)
$105
$32 (drop-off)
$131
280805 (7/10-7/14)
$187
$80 (both ways)
$234
*3-C (6/30)
Friday Fun Days (9a-3p)
$58
$16 (both ways)
$73
280806 (7/17-7/21)
$187
$80 (both ways)
$234
*4-B (7/3-7/6)
Afternoon Only (12p-3p)
$79
$24 (drop-off)
$98
280807 (7/24-7/28)
$187
$80 (both ways)
$234
*4-C (7/7)
Friday Fun Days (9a-3p)
$58
$16 (both ways)
$73
*5-B (7/10-7/13)
Afternoon Only (12p-3p)
$105
$32 (drop-off)
$131
*5-C (7/14)
Friday Fun Days (9a-3p)
$58
$16 (both ways)
$73
*6-B (7/17-7/20)
Afternoon Only (12p-3p)
$105
$32 (drop-off)
$131
*6-C (7/21)
Friday Fun Days (9a-3p)
$58
$16 (both ways)
$73
*7-B (7/24-7/27)
Afternoon Only (12p-3p)
$105
$32 (drop-off)
$131
*7-C (7/28)
Friday Fun Days (9a-3p)
$58
$16 (both ways)
$73
Check here if your childs school will be dropping off
or picking up your child at the LWSRC for Youth camp.
Check here if you are requesting a scholarship.
Note: You must have a completed 2017 Scholarship application on file.
Ages 8-14
TOTALS
Code: 28070*(1-A, 1-B, etc.) Morning and afternoon sessions run Monday-Thursday
Check both morning & afternoon boxes for full day
Week (dates)
Morning / Afternoon
and Friday options
X
LWSRA
Residents
No camp July 4th
X
Resident only
Transportation
X
SSSRA &
Non-Residents
*1-A (6/12-6/15)
Morning Only (9a-12p)
$85
$32 (pick-up)
$106
*1-B (6/12-6/15)
Afternoon Only (12p-3p)
$85
$32 (drop-off)
$106
*1-C (6/16)
Friday Fun Days (9a-3p)
$58
$16 (both ways)
$73
*2-A (6/19-6/22)
Morning Only (9a-12p)
$85
$32 (pick-up)
$106
*2-B (6/19-6/22)
Afternoon Only (12p-3p)
$85
$32 (drop-off)
$106
*2-C (6/23)
Friday Fun Days (9a-3p)
$58
$16 (both ways)
$73
*3-A (6/26-6/29)
Morning Only (9a-12p)
$85
$32 (pick-up)
$106
*3-B (6/26-6/29)
Afternoon Only (12p-3p)
$85
$32 (drop-off)
$106
*3-C (6/30)
Friday Fun Days (9a-3p)
$58
$16 (both ways)
$73
*4-A (7/3-7/6)
Morning Only (9a-12p)
$64
$24 (pick-up)
$79
*4-B (7/3-7/6)
Afternoon Only (12p-3p)
$64
$24 (drop-off)
$79
*4-C (7/7)
Friday Fun Days (9a-3p)
$58
$16 (both ways)
$73
*5-A (7/10-7/13)
Morning Only (9a-12p)
$85
$32 (pick-up)
$106
*5-B (7/10-7/13)
Afternoon Only (12p-3p)
$85
$32 (drop-off)
$106
*5-C (7/14)
Friday Fun Days (9a-3p)
$58
$16 (both ways)
$73
*6-A (7/17-7/20)
Morning Only (9a-12p)
$85
$32 (pick-up)
$106
*6-B (7/17-7/20)
Afternoon Only (12p-3p)
$85
$32 (drop-off)
$106
*6-C (7/21)
Friday Fun Days (9a-3p)
$58
$16 (both ways)
$73
*7-A (7/24-7/27)
Morning Only (9a-12p)
$85
$32 (pick-up)
$106
*7-B (7/24-7/27)
Afternoon Only (12p-3p)
$85
$32 (drop-off)
$106
*7-C (7/28)
Friday Fun Days (9a-3p)
$58
$16 (both ways)
$73
Summer Camp Total =
$_________________
Transportation Total =
$_________________
Combined Total = $_________________
25% due at registration
OFFICE USE ONLY
RES / SSSRA / NR
Received: ___________________
Summer Camp Total $________________
Other Programs
$________________
Scholarship
$________________
amount paid
- $________________
(if applicable)
balance owed
Forms $________________
Park
By: _____________
Check #
Check
_____________
$ _____________
Credit Card $ _____________
Cash Log $ _____________
W/L
lwsra.org/register 9