DayCamp 2018/VBS

Camper's Name *

First

Last

Please Check *

M F

Grade Level *

1st -6th | Grade Completed (at time of camp) *

Birthdate *

Age as of camp *

Camper Parent/ Guardian Name *

First

Last

Camper Email *

Emergency Contact Name *

First

Last

Camper Address *

Line 1

Line 2

City

State

Zip Code

Country

Camper Day Phone Number *

Camper Night Phone Number *

Camper Cell Phone Number *

Approved Driver *

First

Last

My Child Has Permission to: *

Walk or 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.

Emergency Contact Address *

Line 1

Line 2

City

State

Zip Code

Country

Emergency Contact Relationship to Camper *

Emergency Day Phone Number *

Emergency Cell Phone Number *

day_camp_registration_2018__1_.pdf
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ON-LINE 2018 REGISTRATION IS OPEN!

OPTION 1 : FILL OUT ONLINE