Non Elks Kids Week Registration

Please complete the information below and hit submit. You will then need to provide a form of payment to reserve your child's spot at camp.

* Indicates required field

Which Session? *

Child's Gender *

Male Female

Child's Age (at time of camp) *

Child's First & Last Name *

Name of Elks Child / Cabin Mate *

Street Address *

City *

State *

Zip *

Parent / Guardian First & Last Name *

Relationship *

Home Phone # (if no home #, use cell #) *

Relationship *

Primary Email Address *

Cell Phone # (if no cell #, use home #) *

Work / Alternate Phone # *

Has your child been away from home for longer than 2 days previously: *

Yes No

Special Needs (Use Medical Conditions box below to explain checked items) *

Special Education Needs (e.g. para, EIP) Special Dietary Needs (e.g. gluten free) Significant Allergy Special Medical Needs

Is your child a first time attendee or a returning camper: *

First time camper Returning camper

Please describe any medical conditions, treatments or medications *

Is there anything else we need to know about your child *

Continue

Part of the Benevolent and Protective Order of Elks

Minnesota Elks Youth Camp
10860 Co Rd 118
Nisswa, MN 56468
ph: 218-963-2222
youthcamp@mnelks.org