Day Camp 2014

2014 DAY CAMP REGISTRATION FORM

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* Indicates required field

Camper's Name *

First

Last

Please Check *

M F

Grade Level *

Entering Preschool | Kindergaten Full Day 1/2 Day AM 1/2 Day PM

1st -5th | Grade Completed (as of camp) *

Birthdate *

Age as of camp *

Parent/ Guardian Name *

First

Last

Email *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Day Phone Number *

Night Phone Number *

Cell Phone Number *

In Case of Emergency Name *

First

Last

Emergency Contact Address *

Line 1

Line 2

City

State

Zip Code

Country

Day Phone Number *

Cell Phone Number *

Relationship to Camper *

Approved Driver *

First

Last

My Child Has Permission to: *

Walk Home Bike Home Neither

Does Your Child Have Any Behavioral or Emotional Issues We Should Know About? *

Driver Phone Number *

Type of Allergy *

I would like to help with Day Camp! *

Yes! No

Volunteer Address *

Line 1

Line 2

City

State

Zip Code

Country

Volunteer Phone Number *

I hereby give informed and expressed consent for my child to take part in all camp activities under supervision, and agree that the Day Camp or Day Camp personnel will not be held responsible for accidents arising there from. I authorize the Day Camp Healthcare Provider and/or designated Day Camp staff/volunteer to provide appropriate treatment to my child for injuries and/or illness. I understand that the information on this form may be released to the appropriate medical personnel in case of medical emergency. I also understand the failure to disclose medical or emotional problems in advance may lead to serious consequences while at Day Camp. Lastly, I verify that everything contained on this form is complete and accurate, to the best of my knowledge. *

I consent.

I also consent to the use of any photograph of my child or family in future Lutherwood publications. * A copy of this form will be shared with Camp Lutherwood Ministries at the end of the Day Camp week. *

I consent.

Submit

FEES
1/2 Day $25/child
Full Day $45/child

A daily fee of $9 can be paid for anyone not able to attend the entire week.

Registration fees can be paid on the first day of Day Camp.

Registration fees for a family of three or more will be discounted.

Scholarships available — just ask!

﻿2014 DAY CAMP REGISTRATION FORM ﻿

option 1Easy WORD DOC form FILL OUT SAVE AND UPLOAD back!

Upload your day camp registration form

option 2 FILL OUT ONLINE

2014 DAY CAMP REGISTRATION FORM

option 1
Easy WORD DOC form
FILL OUT SAVE
AND UPLOAD back!

option 2
FILL OUT ONLINE