day camp 2015 enrollment form
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Day Camp 2015June 8-12St. Paul Lutheran Church (ELCA) Borchers10792 N County Road 210 ESeymour, IN 47274Phone: (812) 522-7364 or (812)522-7484 email: [email protected]
Camp will meet daily Monday through Friday. Activities will include Bible Study, worship, games, songs, snacks, arts & crafts, stories, and drama. Children will need to bring a sack lunch each day.
Preschool and Kindergarten (ages 2-5; not yet started kindergarten):9:30 a.m. 11:30 a.m.Grades 1-6 (Entering in fall 15) 9:30 a.m. - 2:30 p.m.Special afternoon events Tuesday & Thursday begin around 3:00 p.m.
Day Camp 2015- Registration FormName ________________________________________Birth date ________________________Address ______________________________________Age____________City ___________________ State_______ Zip________ Please circle one that applies E-mail address___________________________________ Grade Next Fall:Parents/Guardians __________________________________ Preschool 1st 2nd 3rd 4th 5th 6thHelpers Only- 7th 8th 9th 10th 11th 12th AdultHome Phone___________________________ Cell Phone____________________________ Ok to text _________Person to Contact First if needed during day camp hours ___________________________Emergency Phone Number__________________________________ Contact Preference e-mail__________ Text________ Facebook_________Day Camp T-shirt size: Youth XS (2-4) Youth S (6-8) Youth M (10-12) Youth L (14-16)Adult S M L XL XXL -Over-
DAYCAMP 2015 MEDICAL RELEASEI/we, ___________________________________________________ as parent(s) or guardians of ________________________________________________________ (childs Name) delegate my / our legal authority to consent to healthcare on behalf of such child to St. Paul Lutheran church (Borchers). This delegation is to be exercise to good faith and in the best interest of my/our child. This delegation is effective June 8, 2015 up to and including June 12, 2015Signature of Parent(s): _________________________________Date _________________
MEDICAL INFORMATIONChilds Name: __________________________________________________Allergies _______________________________________________________Dietary Restrictions______________________________________________Present Medications: ____________________________________________Any Medical condition(s) physician should know about: _____________________________________________________________________________________________________________________________________________________
Please note the attached sheet of afternoon events. An adult, responsible for your child, must be present at the pool for them to participate. Transportation will be provided to the afternoon events. If your child is going in the afternoon please let the person signing them in know.Photographs may be taken of you child for use on our website. If you have a concern with this please talk to one of the directors or the pastor.