Shetek Day Camp 2019 at FLC
Camper Registration and Health Form
First Lutheran Church, St. Peter
Camp is June 24-27, 2019
9 a.m. - 2:30 p.m.
Cost: $50/camper; $120 family maximum
Payable to First Lutheran Church
Snack is provided. Campers bring their own lunch.
Email address *
Camper's Name (First and Last) *
Your answer
Gender
Age
Your answer
Grade entering in fall 2019
Birthday
MM
/
DD
/
YYYY
Address (street, city)
Your answer
Parent or Guardian Name
Your answer
Primary Phone Number
Your answer
Preferred email
Your answer
Name of emergency contact
Your answer
Relationship to camper
Your answer
Emergency contact phone number
Your answer
Name of alternate contact
Your answer
Relationship to camper
Your answer
Alternate contact phone number
Your answer
Family physician's name/clinic
Your answer
Phone number of clinic
Your answer
Indicate any special physical, dietary, or emotional needs of the camper
Your answer
Current medications
Your answer
Authorization of parent/guardian: I hereby give my permission for my child to participate in day camp and activities planned by the Shetek staff for the day camp program. Shetek Lutheran Ministries may use any pictures or videos that my child appears in for promotional purposes. I also authorize delivery of necessary emergency care by available medical personnel as needed.
How did you learn about day camp at First Lutheran church?
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