St. Luke's Community Camp 2018 Registration
Monday, July 30th - Friday, August 3rd
Which version of camp will you child(ren) attend? *
Will you require early drop-off or late pick-up? (If so, provide the hours you'll need below)
Your answer
First Child's Full Name (& nickname) *
Your answer
First Child's Age (& full birthdate) *
Your answer
Second Child's Full Name (& nickname)
Your answer
Second Child's Age (& full birthdate)
Your answer
Third Child's Full Name (& nickname)
Your answer
Third Child's Age (& full birthdate)
Your answer
Fourth Child's Full Name (& nickname)
Your answer
Fourth Child's Age (& full birthdate)
Your answer
Parent/Guardian Name(s): *
Your answer
Phone #(s):
Your answer
Emergency Contact (name and relationship): *
Your answer
Emergency Contact (phone #): *
Your answer
Please advise us of any emotional or mental health needs that might help us fully connect with your child. *
Your answer
Please advise us of any allergies we'll need to avoid in our camp. *
Your answer
Primary physician (name & number): *
Your answer
Being the parent or legal guardian of the above-named child(ren), I give my consent to emergency medical and surgical treatment in the event that such treatment becomes necessary. I grant my permission for treatment in a licensed hospital by a licensed physician and the physician’s assistant and designees. I understand that hospital personnel will make reasonable attempts to contact me before initiating treatment. The minor(s) named in this consent may receive all treatment provided according to generally accepted standards of medical practice. My consent is effective for the time period from July 30th through August 3rd, 2018. (Type name below by way of signature.) *
Your answer
I, the parent or legal guardian of the above named child(ren), give my permission to St. Luke's Community Camp 2018 to post my child(ren)’s picture in hard copy or on the camp's website. I understand that my child(ren)’s name(s) will not be posted with her/his/their picture(s). *
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