Celebrate Summer Registration
Please complete all fields to register for the Trinity Lutheran Celebrate Summer Program.
Upon completion of this form I understand the following:
- This form is for one child.
- A $50 non-refundable deposit per week per child must be submitted before registration can be completed.
- This deposit will be deducted from my final balance.
- Payments may be mailed to: Celebrate Summer, Trinity Lutheran School, 40 West Nicholai St. Hicksville, NY. 11801
- Final balance is due two weeks prior to attending Celebrate Summer.
- Celebrate Summer participants may be photographed or videotaped for the purpose of positive program communication and publicity, unless the parent or guardian submits a written request that their child not be photographed or videotaped.

* denotes a required field

I, the parent or guardian of the child listed below, have read and understand the above text. *
Required
Camper's Name *
Your answer
Camper's Date of Birth *
MM
/
DD
/
YYYY
Grade as of September 2019 *
Parent 1: First and Last Name *
Your answer
Parent 1: Address *
Your answer
Parent 1: Cell Phone *
Your answer
Parent 1: Daytime Phone *
Your answer
Parent 1: Home Phone *
Your answer
Parent 1: Email *
Your answer
Parent 2: First and Last Name
Your answer
Parent 2: Address
Your answer
Parent 2: Cell Phone
Your answer
Parent 2: Daytime Phone
Your answer
Parent 2: Email
Your answer
In case of an Emergency, please list who should be contacted should neither parent be reachable.
Emergency Contact: Name *
Your answer
Emergency Contact: Phone Number(s) *
Your answer
Emergency Contact: Relationship to Child *
Your answer
Emergency Care Authorization
I give permission to the staff of Trinity Lutheran Celebrate Summer Program to administer First Aid to my child. In an emergency, when the parents and emergency contact listed above cannot be reached, I authorize that appropriate measures be taken to secure treatment, including arranging for transportation to the nearest emergency room.
I authorize the above.
Please select which weeks and days your child will be attending camp.
Note that Week 5 offers two options for campers ages 4-11. Please choose one: Only Celebrate Summer, or Vacation Bible school from 9am - 12pm, combined with Celebrate Summer from 12pm - 4pm.
Week One July 1st - July 5th
Week Two July 8th - July 12th
Week Three July 15th - July 19th
Week Four July 22nd - July 26th -- Celebrate Summer
Week Four July 22nd - July 26th ~ Celebrate Summer and Vacation Bible School
Week Five July 29th - August 1st
Week Six August 3rd - August 9th
Week Seven August 12 - August 16th
Please choose the size for camper's Celebrate Summer T-Shirt *
How did you hear about Celebrate Summer? *
Your answer
Would you like to be sent information about Trinity Lutheran School? *
Required
The following people are allowed to pick up my child from Celebrate Summer.
Person 1: Name *
Your answer
Person 1: Phone Number *
Your answer
Person 1: Relationship to Child *
Your answer
Person 2: Name
Your answer
Person 2: Phone Number
Your answer
Person 2: Relationship to Child
Your answer
Person 3: Name
Your answer
Person 3: Phone Number
Your answer
Person 3: Relationship to Child
Your answer
Please list any additional person(s) who may pick up your child.
Your answer
I understand that registration is only complete when a deposit has been received. *
Required
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