Little Louies Day Camp Registration

Thank you for your interest in Recreation & Wellness's Little Louies Day Camp!

Payment will be collected at the time of registering. Please complete the form in it's entirety.

Camper Information

Camper Full Name (First, Middle, Last) *

Name Camper Uses (ex: Nickname, chosen name) *

Age on First Date of Program *
Please enter a number between 6 and 12.

Date of Birth *

Tshirt Size *

Address Line 1 *

Address Line 2

City *

State/Province *

Zip/Postal Code *

Parent or Legal Guardian Information

Parent First Name *

Parent Last Name *

Email *

Email (Confirmation)

Phone *

Parent/Legal Guardian Address is different than Camper *

Parent/Legal Guardian Address

Address Line 1 *

Address Line 2

City *

State/Province *

Zip/Postal Code *

Emergency Contact

Emergency Contact First Name *

Emergency Contact Last Name *

Emergency Contact Phone *

Relationship to Camper *

Additional Emergency Contact Needed? *

Additional Emergency Contact

Emergency Contact Last Name *

Emergency Contact First Name *

Emergency Contact Phone *

Relationship to Camper *

Authorized Adult for Pick Up

Authorized Adults for Pick Up (select ALL that apply). *
Parent/Legal Guardian listed above
Emergency Contact listed below
Add additional authorized adult

First Name *

Last Name *

Contact Phone *

Relationship to Camper *

Session Registration

Session(s) *
Session 1: June 8-12 ($260.00, 60 available)
Session 2: June 15-19 ($260.00, 58 available)
Session 3: June 22-26 ($260.00, 57 available)
Session 4: July 6-10 ($260.00, 60 available)
Session 5: July 13-17 ($260.00, 60 available)
Session 6: July 20-24 ($260.00, 60 available)
Session 7: July 27-31 ($260.00, 60 available)
Session 8: August 3-7 ($260.00, 60 available)
Session 9: August 10-14 ($260.00, 59 available)

Medical, Health, & Disability

The minor child requires accommodations due to a disability. If yes, the parent/legal guardian must inform (with sufficient notice) and cooperate with the Programming Team to determine if Reasonable Accommodations can be made. *
Yes
No

The minor child has other nutritional, physical, medical, social or emotional conditions or needs that staff should be aware of prior to participation in this Program. If yes, describe below. *
Yes
No

Please describe below *

Waivers & Releases

Electronic Signatures

Electronic signatures and electronically transmitted documents are binding.

Transportation (pick-up and drop-off)

Pick Up/Drop Off

Drop off: Between 8:30am - 9:00am
Pickup: Between 4:00pm - 4:30pm
Location: All drop offs and pickups will be held at the Fieldhouse Circle Drive, located off of Lot C1, which is on the north side of the Fieldhouse. Details and a map will be provided in the parent packet delivered via email after registration.

Pick up is only permitted by parent/guardian, emergency contact, or additional 18+ adult as submitted on your registration form. Photo ID verification and signature are required at pick up.

The GVSU Authorized Adult(s) overseeing the pick-up and drop-off of Program Participants shall remain at the specified location until all minor children have been released. If a minor is not picked up, the Authorized Adult(s) will contact the parent/legal guardian, the Program Director, emergency contacts, and finally, Grand Valley Department of Public Safety, if needed.

As the parent/legal guardian of the minor child, I certify that I have received, read, and I understand the drop-off and pick-up procedures provided by the Program. If the minor child is not exempted, and special arrangements need to be made, I understand that it is my obligation to inform the Program in a timely manner. I understand the escalation procedures if the minor child is not picked up in accordance with the pick-up procedures.

Transportation (pick-up and drop-off) *

Parent/Legal Guardian Initials and Date

Behavior and Conduct

All Programs, Program Directors, Authorized Adults, and Participants, including minor children and their parents/legal guardians are subject to standards outlined in GVSU’s University’s Policies, and (if applicable) Program-specific Conduct or Behavioral Expectations.

As the parent/legal guardian of the minor child, I certify that GVSU’s University’s Policies, and (if applicable) Program-specific Conduct or Behavioral Expectations have been provided to me. I understand that Participation in the Program, including the minor child’s Participation, is subject to those standards. I also understand that if the minor child does not meet the prescribed standards of behavior, they may be asked to leave the Campus and/or Program immediately and may be expelled from the Program.

Behavior and Conduct *

Parent/Legal Guardian Initials and Date

Media and Likeness Permission & Release

I hereby authorize Grand Valley State University to:

(a) Capture or record the minor child’s name, likeness, image or voice in photographic, audio, video, digital or other forms or technologies (“Recordings”)

(b) Use, reproduce, publish, exhibit, or distribute those Recordings for any lawful reason including promotional, commercial, information, and educational purposes; using any type of media now existing or hereafter developed, as may be consistent with the Program’s mission

I waive any rights or action I may have and release Grand Valley State University, its licensees and assigns, from any claim(s) I may have arising from the use of the child’s likeness; including any rights to sue for defamation or violation of any rights of privacy and publicity.

Media & Likeness Ageement *

Media & Likeness Permission and Release *

Parent/Legal Guardian Initials and Date

Facilities Waiver

By initialing below, I acknowledge as a parent or guardian that I have read and agree to the guidelines listed in this waiver.

Facilities waiver

Facilities Waiver *

Parent/Legal Guardian Initials and Date

Acknowledgement, Waiver/Release and Permission

As the parent/legal guardian of the minor child, I certify that the above information is the most up-to-date and correct to the best of my knowledge. I agree to the conditions noted herein as conditional to the minor child’s participation in GVSU Programs and related activities. I agree to release and agree to hold GVSU, its Board of Trustees, students, employees, and assigns harmless from all claims, actions, damages or liabilities for personal injury, damage, or illness relating to or arising out of any activity; except where the injury, damage or illness is caused by the gross negligence of the university’s employees.

The minor child has my permission to participate in this Program.

Parent/Legal Guardian Printed Name *

Acknowledgement, Waiver/Release and Permission *

Parent/Legal Guardian Signature and Date

Page last modified April 8, 2026

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