St Paul Lutheran Church VBS Day Camp 2019 Registration Form
Dates: June 24th-28th
Hours: 9 am - 3:30 pm
Are you registering a: *
Name *
Birth Date *
Grade Most Recently Completed *
Home Address
Parent/Guardian Name *
Phone Number *
Parents Email
Emergency Contact Name and Phone (if parent can't be reached) *
Physician & Their Phone Number *
Insurance Carrier & Group/Policy Number
Home Church
Any restrictions to Physical Activities?
Any Allergies (food, drugs, insects, etc.)?
Please List the Names and Phones Numbers of people who may pick your child up from Day Camp: *
Release: I will not hold Lutherhill Ministries or St Paul Lutheran Church Staff and Volunteers responsible for accidents, claims and damages arising from my child's participation in Day Camp activities. I also give permission to use any photographs/video of me or my child, taken at Day Camp, for future promotional purposes. If yes, please put name and date below. *
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