St Paul Lutheran Church VBS Day Camp 2019 Registration Form
Dates: June 24th-28th
Hours: 9 am - 3:30 pm
Are you registering a: *
Required
Name *
Your answer
Birth Date *
Your answer
Grade Most Recently Completed *
Your answer
Home Address
Your answer
Parent/Guardian Name *
Your answer
Phone Number *
Your answer
Parents Email
Your answer
Emergency Contact Name and Phone (if parent can't be reached) *
Your answer
Physician & Their Phone Number *
Your answer
Insurance Carrier & Group/Policy Number
Your answer
Home Church
Your answer
Any restrictions to Physical Activities?
Your answer
Any Allergies (food, drugs, insects, etc.)?
Your answer
Please List the Names and Phones Numbers of people who may pick your child up from Day Camp: *
Your answer
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. *
Your answer
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