2020 Youth Camp Sessions

Updated June 2020 (New Items in BOLD)

PACKING CHECKLIST

Medical Information/Parent Permission form

Pre-Screening Health Form

Any medicines (If applicable)

Bible

Sleeping bag or other bedding

Pillow

2 or more Cloth Face Covering in a labeled plastic bag*

Shirts & shorts

1 or 2 pairs of pants

Changes of underwear & socks

Pajamas

Two pairs of tennis shoes

Beach shoes (eg: flip-flops)

Swimsuit & Towel

Jacket/Long sleeve shirt

Raincoat or poncho

Costume/accessories for theme night

Towel & washcloth

Soap & shampoo

Toothbrush & toothpaste

Plastic Bag or Container for Toiletries*

Other hygiene items

Sunscreen

Insect repellent

Laundry Bag*

Plastic garbage bag in case of muddy/wet clothes

Stationery, envelopes, & stamps

Pen or pencil

Camera (no cell phones or other smart devices please)

Flashlight with fresh batteries

*See next page for details.

We are excited that you are joining us this summer. This handbook includes information to help you have a successful time at Camp this summer. Here is a short checklist for getting started...

Print & fill out Medical Form Contact Camp with special requests Make plans for Drop-off and Pick-up Plan your theme night outfit Pay Balance (Don’t forget the Camper Bank) Get excited! Print & fill out Pre-Screening Health Form

In order to make Check-In a speedy and pleasant process, we ask parents to note the following information. In order to minimize potential transmission of COVID-19, Camp requests families come with only one adult per camper and that siblings not attending camp, stay home if possible. Upon arrival at Lutherhaven:

1. Follow the circle drive to the RIGHT around the Camp office, where your camper’s temperature will be taken and you will show your camper’s completed Pre-Screening Health Form to a staff member.

2. If your camper’s temperature is below 100.4, you will proceed to the parking lot to park and go to the Daniel Retreat Center for Check-In.

3. Check-In will take place in shifts by last name on Sunday afternoon.

Campers whose last name begins with A-M - from 1:00 to 1:45pm Campers whose last name begins with N-Z - from 1:45 to 2:30pm

If you are unable to be at Camp at your scheduled time, please notify the office at least 48 hours beforehand to make special arrangements.

4. Once you complete Check-In, you will head to the cabin to meet their counselor and move in. This year, only campers and counselors will be allowed to enter the cabins. Parents/guardians will be asked to remain on the porch, in an effort to reduce the potential spread of COVID-19.

5. There will not be an opening event in the Pavilion for families and campers this year. Once your camper has moved in and goodbyes are said, the Camp adventure will begin (Lutherhaven is on EDT).

You may make your final payment by choosing one of the following options.

Online Payments, including camper bank deposits or Memory DVD purchases may be made by logging into your online account. A link was sent in your confirmation email and can also be found at www.lutherhaven.org.

Or Mail your payment listing the camper’s name and camp program.

PAY BALANCE 24 HOURS PRIOR TO CHECK-IN

WELCOME!

SUNDAY CHECK-IN *NEW PROCEDURES*

This year, in an effort to reduce transmission of COVID-19, Camp Lutherhaven will not have a public Sunday Morning Worship, a dinner, or open beach time. We hope you will join us for this weekly event next year!

SUNDAY MORNING

COVID-19 MEDICAL

PROTOCOL If a camper or staff member is suspected to have COVID-19 based on their symptoms or temperature…

Immediate care and support will be given. We know it could bring about a lot of fears.

A facemask will be placed on the individual to lessen the potential of spreading the virus.

The individual will be brought to an area at least 6 feet away from others.

The medical staff will begin care for the individual and assess the symptoms.

Camp will notify parents/guardians of campers to make arrangements for potential pick-up.

This year, in an effort to reduce transmission of COVID-19, there will not be a closing program for families on the last day of camp. Parents/guardians will pick up their camper in shifts, based on the first letter of the camper’s last name.

Campers whose last name begins with A-M from 4:00 to 4:30pm Campers whose last name begins with N-Z from 4:30 to 5:00pm Only campers and counselors will be allowed to enter the cabins. Parents/guardians will be asked to remain on the porch. If you need to pick your child up early, please make arrangements at Check-In on Sunday.

FRIDAY PICKUP

All campers will be required to go through a brief medical screening during Check-In, prior to attending camp. If your child shows signs of illness, they may be asked to go home and reschedule for a camp session later in the summer.

CAMPER MEDICAL SCREENING

FILL OUT YOUR CHILD’S MEDICAL INFORMATION/PARENT PERMISSION FORM

In this packet, you received the Medical Information/Parent Permission Form AND the Pre-Screening Health Form that are to be presented at the time of registration. The Pre-Screening Health Form needs to be started 14 days prior to arriving at Camp.

If needed, you may also download the forms from our website. Please read through both forms carefully, complete, and sign your name. Camp Lutherhaven reserves the right to refuse/delay registration for ill or injured campers and send home campers who become ill or injured while at Camp. (NOTE! All over-the-counter and prescription medicines MUST be turned in at registration except for inhalers and topical creams as prescribed by your physician for self-administration. Label all medication with the child’s name and any special instructions. Prescribed medication must be in its original container and state the camper’s name and doctor’s instructions. If your child has a food intolerance or food allergy, please contact Camp at least one week prior to arrival.)

NEW PACKING LIST ITEMS

Cloth Face Covering: Camp staff and campers may be asked to wear cloth face coverings when they are unable to follow social distancing protocol with someone outside their cabin or family group. It is strongly recommended campers bring their own cloth face covering(s) with them. This could be a bandana, cloth face mask, buff, etc…

Laundry Bag: We suggest that you send a plastic bag (i.e. garbage bag) that the clothing items from your camper can be placed in on their final day of camp. This will help prevent the spread of germs before you are able to launder their clothes.

Toiletries: Please be sure to provide a container (i.e a bathroom tote or a 1 quart plastic bag) that can be used for hygiene products so that items such as toothbrushes, glasses, hairbrushes, etc. can be safely stored separately from other campers’ items.

Every child will receive a free group photo of the campers and staff in their session.

Memory DVD’s will have videos from your camper’s time at Camp and will include all of the participants of your child’s program. The DVDs are sold for $7 and will be distributed to campers on the last day of camp. If you have not already paid for this optional purchase with your initial registration, you may include it during Sunday’s Check-In.

Camper bank money is available on a paperless, credit basis to the campers twice a day during Canteen as well as in the Craft Room. Most children in full week camps spend $12-$25; and the maximum amount allowed is $30. If you did not already deposit money into the camper bank, you may still make a deposit during Sunday’s Check-In. Any remaining funds will be donated to Lutheran Bible Translators which makes God’s Word accessible to those who do not yet have it in the language of their hearts. Learn more at lbt.org. You may also choose to have the remaining balance returned to you on the last day.

Please see the 2020 Theme Nights sheet in this packet to find what theme night is planned for your child’s visit. That way, they may fully participate in the festivities with the rest of the Camp on this special night.

We ask that campers remain at Camp throughout their session. However, we understand that there are some unavoidable circumstances where leaving may be necessary. If your child must leave during their Camp session, please be prepared to provide the day(s), times and who will be picking up/dropping off your child. If your child must arrive at Camp late or leave early, please notify the office in advance. An additional health screening will be required before they return to Camp. Always check in at the Office first when any of these pick-ups and/or drop-offs are necessary.

Your $50 deposit if applicable is non-refundable except for instances of camper injury, camper illness, death in the family, or Covid-19.

If we can help you in any way, please call the Camp office Monday through Friday, 9 am to 5 pm at 260.636.7101. For more information about Camp Lutherhaven, please visit our website at www.lutherhaven.org.

Camp Lutherhaven is located off State Road 9 and U.S. 33, thirteen miles north of Columbia City, five miles south of Albion, and twenty-six miles northwest of Fort Wayne. Use State Road 9, or U.S. 33, and this map to find your best route to Camp, or enter our address below into your GPS device.

THEME NIGHT

DIRECTIONS

QUESTIONS?

REFUNDS

CAMPER BANKS

MEMORY DVD’S

PHONE I n kee p in g w i th C amp

Lutherhaven’s community policy

(see next page) cell phones may

not be left with campers.

However, we recognize that

there may be a special

circumstance where a phone call

i s the best opt ion for

communication with your child. If

you would like to talk on the

phone with your child, please call

the Camp office or speak with a

staff member at Check-In and we

would be happy to make

arrangements to do so.

MAIL

We encourage you to send a

letter to your camper at:

Camp Lutherhaven

Camper’s name and cabin #

1596 S. 150 W.

Albion, IN 46701

E-MAIL You may also e-mail your child

while he/she is at Camp.

However, we are unable to allow

campers to e-mail you a

response. To e-mail your child,

please click on:

Summer Camp/moosemail

at www.lutherhaven.org. For all

e-mail received by 1 pm each

day, we will print your e-mail and

include it in our dinnertime mail

distribution.

CAMPER COMMUNICATION

SPECIAL REQUESTS

FREE PICTURE

Camp will be making some changes for Summer 2020 with COVID-19 in mind. Please review them and talk them over with your camper so they know better what to expect.

Daily Health Screening: All staff and campers will have their temperature taken daily with a temporal thermometer and will be asked about any symptoms they are experiencing.

Anyone with a temperature of 100.4 or over will immediately be isolated and monitored for additional symptoms.

Parents must be ready to pick up their child if they show any symptoms or continued high temperature.

Each cabin will have a maximum of 8 campers, 1 Junior Servant, and 1 Counselor. Sleeping: Campers will sleep head-to-toe, or toe-to-toe, to maximize distance between heads/faces. (This

means your camper’s head will not be the same direction as their friend’s head when sleeping in bunk beds.) Cabins will be sanitized daily.

Camper Interactions: Campers will primarily spend time in their cabin groups and family groups and will practice social distancing in large group settings. In the case of an emergency, social distancing procedures may not be followed in order to keep campers safe.

In order to safely and consistently manage the interaction of groups on camp, there will not be traditional Free Time this year. Instead, cabins will do more activities together, including beach time, archery, and various other camp activities.

Hand Hygiene: Campers will wash their hands and use hand sanitizer on a regular basis. Showers: Shower times will be scheduled and campers will be asked to shower daily.

Tables will be spaced 6 feet apart. Meal times will be staggered with half of the camp eating in the Dining Hall at a time Campers will wash their hands before entering the dining area. Meals will be served by the counselor at each table.

Even with all these changes, we are looking forward to an

epic summer adventure.

Thank you for joining us, we are excited you are

joining us this summer!

CHANGES TO CAMP FOR 2020

MEDICAL PROTOCOLS

CABINS

ACTIVITIES

HYGIENE

MEAL PROCEDURES

COMMUNITY POLICY

One of the awesome things about summer camp at Camp Lutherhaven is the opportunity to experience a special Christian community in

the midst of God's creation. In order to achieve this goal, it is expected that participants come with an attitude of cooperation, goodwill,

and respect for each other and God's creation. Please carefully consider your language, dress, and behavior before arriving. Cursing,

revealing or inappropriate clothing, and disrespectful or harmful behavior will not be tolerated. In addition, items such as cell phones and

other electronic devices can become disruptive and a distraction to the formation of Camp community, relationships, and interaction

with creation around them. Because of this, cell phones are not allowed to be in the possession of those 18 years and under. Camp

Lutherhaven reserves the right to send a camper home that is unable to abide by this policy. We thank you for your cooperation.

Our counselors bring an excitement for life and a love for children and youth.

The relationship they develop with your child has the potential to become an

important one in their life.

Here are some things you may want to take the time to notate on the medical

form as well as inform the counselor about so that they can help your child

have a great time at Camp.

Any night time procedures that may comfort him.

How to address her ADD, Autism, or other behaviors.

How you have equipped him to communicate about any problem.

Any allergies she may have.

Any dietary restrictions he may need.

You may be surprised what concerns your child has about Camp. Having a

discussion about this new adventure can prepare your child to walk away with

a healthy sense of independence, further developed social skills, more

confidence and a stronger sense of self-worth. Below are some discussion tips.

Reinforce that Camp is a safe place for them to be.

Explain that it is natural to have some apprehension.

If this is their first time away from home, ask them about any questions

they may have or how they feel about being away from home.

Help her to understand that she can come to her counselor or other staff

with any concern or need.

Invite him to pray with you.

Take time to equip her with scripture.

Focus on the positive aspects of Camp.

Tell him that you have faith in his ability to handle the situations he may

face while at Camp.

Ask if she has any concerns specific to Covid-19. She will be among larger

groups of people and away from the rhythm you have created at home.

Reassure her that Camp is doing everything to keep her healthy and safe.

PRE-CAMP ANXIETY

CAMP COUNSELORS

Coming to an overnight experience at Camp Lutherhaven is an impactful experience for your

whole family. Whether your child is a novice or a well-seasoned camper, what you do and say to prepare

your child can have a profound impact on how they experience a program at Camp. Below are some

helpful suggestions for making your child’s time at Camp a success.

COMMUNICATING WITH YOUR CHILD WHILE AT CAMP

We encourage you to keep in touch with your child through email or by letter while they are at Camp. Here are some

pointers:

Be sure to sound upbeat and positive.

Remain focused on the things he is experiencing at Camp.

Share some encouraging scripture with her.

Avoid mentioning things that he might be missing at home.

Reassure her of your love.

Let him know that you’re confident he can handle it.

Express your pride in her achievements so far.

For details on how to get in contact with your child, check out the camper communication section on the second page.

HOMESICKNESS

Our goal is to make Camp a safe place for your child. Below are ways that our staff will walk alongside a camper who is

experiencing homesickness.

Staff will first create a safe and welcoming environment.

Acknowledge camper’s feelings - let them know it’s OK to feel that

way.

Notify other staff of the situation.

Work through possible solutions that may include:

Focusing on activities, future fun things, and learning new skills

Inviting them into conversation

Connecting them up with new friends

Extra TLC

Notify parent(s) of child’s condition if the homesickness lasts

throughout the day or if a child is asking to call home.

Decide on a strategy with the parent(s) which may include:

A letter from home

A phone call between parent(s) and child*

Last Resort: taking your child back home. They just may not be ready to be at Camp this year.

*We typically discourage phone calls because it can often increase the intensity of their emotions. In fact, if you receive a

letter about how horrible the Camp, the food, other campers, the counselors are, don’t panic- that’s not atypical of what

children may express when experiencing homesickness, especially early on. And of course, call us if you have any concerns.

The emotions you and/or your child may feel during separation are

completely legitimate. Our first overnight camp begins at first grade;

however, we’ve seen intense homesickness well into the high school

years. Most campers, however, are able to work through these

emotions and come away from Camp with a wonderful experience.

Below are some things you can do to help head off homesickness.

Spend time getting a clear sense of what Camp will be like

* Look through a friend’s photos, or the Camp website

* Arrange a visit to Camp

Practice being away from home by spending an overnight at a

friend or relative’s house.

Strive to keep your own emotions in check.

Keep your comments positive about this time away.

Focus on the potential rewards such as gaining confidence, new

friends, and the fun of new adventures.

Write a letter or e-mail that will arrive the first few days of Camp.

WHAT IS THAT?

OUR TYPICAL SCHEDULE

7:00 Polar Bear Wake up

7:45 First Word/Breakfast Cabin Clean-Up/Showers

9:45 Powertime

10:15 Family Group Time

12:00 Lunch Fun in the Son

2:00 Rest Period

3:00 Beach Family Group Activity

4:00 Group Games

4:45 Canteen/Rec. Family Group Act.

5:45 Supper Cabin Activity

7:45 Evening Activity

8:45 Canteen

9:15 Campfire Devotions

10:00 Showers and Get Ready for Bed

10:45 Lights Out

Cabin Activity: Each cabin gets to choose their activity. Perhaps they will challenge another cabin to a game of Ultimate Frisbee, head out

into the woods for a hike, work on archery skills, swim in Lake Muncie, play in Camp’s bubbling spring, or make some treats for the

evening. The opportunities are endless...limited only by the creativity of the counselor and campers.

Cabin Clean-up: Everyone helps keep Camp Lutherhaven clean! Sure it’s a little work, but at Camp, even work is fun!!

Campfire Devotions are where the depth of God’s Word is shared by the campfire as the staff leads devotions. Just the right mix of music,

humor, and meaningful skits brings the focus upon Jesus Christ as we end the day.

Canteen: What goes better on a hot summer’s day than an ice cream sandwich and a drink? Maybe a candy bar or a drumstick? Good stuff

and a great chance to hang out with cabin-mates or friends in your Family Group.

Evening Activity: All of camp gathers together for instructions on the large group game as fun is sure to be had by everyone!!!! Capture the

Flag, Candy Landerhaven, or Wacky Olympics, who knows what it could be?

Family Group Time: Every morning Family Groups, made up of two to three cabins, gather for sessions of incredible activities! Ranging

from a nature hike to Petty Pond, group building activities, making crafts, archery, boating, to playing a rousing game of Garbage Ball

in the athletic field! Every day is different!

Fun in the Son Bible Studies: At Camp we have a great setting where we often learn through experience, during Bible Studies, cabins may

be found building sand castles to see how our earthly lives are just temporary, or leading a blindfolded cabin-mate through an obstacle

course to show how God leads us even though we have been blinded by our sins. Discussion is emphasized so campers and

counselors can share their faith with each other in an environment where there are no dumb questions.

Group Games: Once a day our awesome team of Junior Servants and a staff member will lead the campers in some epic games and

activities.

Meals: At Camp even finicky eaters enjoy our meals, that are both youth friendly and delicious. Of course, there is always PB&J available.

There may also be various other activities to participate in like first word, dinner time mail delivery, moose kissing, and silly songs!

Polar Bear: Follow Mama and Papa Polar Bear down to the waterfront. Give your best polar bear GRRRRRROOOOOOWLLLLLL!!!, turn

to the north for the polar bear salute, and then, on cue, splash into the water for a quick dip.

Power Time: Campers and counselors spread out around Camp to spend time alone with God as we pray and read from God’s Word.

: This summer, meals will be enjoyed in shifts. While half the camp is dining, the other half of camp will do the activity listed and then

the groups will switch.

FANTASY EVER AFTER (STORYBOOK)

OLYMPICS

What better way to spend the night than enjoying an evening festival with all your

favorite fantasy figures? Dragons, knights, unicorns, ogres, or even talking donkeys!

Who knows what royalty or villains might show up! Come and find out an be sure

to bring along your own magical creature!

July 5th - 10th –Discovery, Treetop D. Explorer 5 & 6

July 26th - July 31st –Youth 6, Adventure Unlimited, Treetop G

Wish you were born in a different time period? Here’s your chance to celebrate

your favorite one. Pick a decade…any decade… and sport those classic trends

from that era in history. Pull out those poodle skirts, polyester, and parachute pants.

Bring on the beads, big hair, and bellbottoms. It’ll be an event for the ages!

July 19th - 24th –Youth 5, Treetop F, Explorer 7 & 8

Come dressed to celebrate the 2020 Olympics! Let the games begin! It’s time to pull

out your running shoes, racquets, and swim goggles. Support the good ole’

USA or represent another country. You may see past medalists Simone Biles

or Hussein Bolt. Grab your BMX gear, practice your bicycle kick and join

your team for this thrilling evening. Your cabin may even have a chance to

practice synchronized swimming!

July 12th - 17th –Youth 4, Treerop E, Youth 4.5A & B

August 2nd - 7th –Youth 7, Soccer Camp, Treetop H, Explorer 9 & 10

A TWIST IN TIME (TIME TRAVELERS)

At Camp Lutherhaven, everyone gets a little crazy on Thursday nights. So, in order to bring some extra fun and focus to the

chaos, please search below for your camp program and see what theme will be reverberating through this special night at

Camp Lutherhaven. Also, look for what special items you may want to bring to dress up.

 

Camper Pre‐Screening Health Form Camp Lutherhaven Summer 2020 

We are grateful for your partnership in providing a safe and healthy camp environment this summer at 

Camp Lutherhaven. In an effort to minimize illness, we ask you to check daily on the health of your camper 

beginning 14 days prior to arriving at Camp. The best camp sessions start with healthy campers and this 

begins at home.  

Please bring this completed form to Camp registration check‐in. 

Camper’s Name:        

Camp Session:        

 

14 Day Self‐Isolation Recommended 

We are recommending that immediately before your camper’s arrival to Camp Lutherhaven, they complete 14 days of self-isolation to reduce their risk of exposure to COVID-19. By self-isolation, we mean limiting exposure to non-family members, wearing a face covering around non-family members, avoiding large crowds/gatherings, and limiting unnecessary travel. 

Symptoms in the 14 Days Prior to Arrival at Camp: Check any that apply to your camper.

Fever of 100.4 F or greater  New or worsening cough  Shortness of breath  New or unexplainable sore throat 

New loss of taste or smell 

Unexplainable diarrhea or vomiting 

Muscle or body aches

If any of the above apply to your camper, please call the Camp office at 260-636-7101 to discuss your situation and options prior to arrival. It is possible that we will ask you to consider rescheduling or not attending camp this summer. 

MY CAMPER HAS BEEN SYMPTOM FREE FOR THE PAST 14 DAYS  INITIAL HERE     

Daily Temperature Checks 

As part of your partnership with us, please record your camper’s temperature for seven days prior to your 

arrival at Camp Lutherhaven. 

Day One  Day Two  Day Three  Day Four  Day Five  Day Six  Day Seven 

  

           

 

MY CAMPER HAS BEEN FEVER FREE FOR THE PAST SEVEN DAYS  INITIAL HERE     

 

Contact History: Check any that apply to your camper in the 14 day time period prior to their arrival at Camp.

Your camper has had close contact with someone exposed to, or infected with COVID‐19. 

Your camper has a household member currently on a watch list for COVID‐19 exposure. 

Your camper is coming from a “high risk” area for COVID‐19. (This includes areas still under stay-at-home orders. In Indiana, this would be defined as Stage 1.) 

If you checked any of the above questions, please call the Camp office at 260-636-7101 to discuss your situation and options prior to arrival. It is possible that we will ask you to consider rescheduling or not attending camp this summer. 

I HAVE ANSWERED CORRECTLY TO THE BEST OF MY KNOWLEDGE       INITIAL HERE     

Pre‐Existing Illnesses or Conditions:  Check any that apply to your camper.

Cardiovascular Disease  Respiratory Disease (including Asthma) 

Diabetes  Immunocompromised 

Individuals with a preexisting illness or condition such as the ones mentioned above are at an increased risk of severe illnesses if COVID-19 is contracted.

I UNDERSTAND THE IMPLIED RISK OF PRE‐EXISTING ILLNESSES/CONDITIONS   INITIAL HERE      

I hereby state that this health screening form is correct as far as I know. I also acknowledge that despite Camp 

Lutherhaven’s reasonable efforts to mitigate the spread of communicable disease, participating in Camp activities 

may result in exposure to COVID‐19 or other communicable diseases, which could result in quarantine measures, 

serious illness, disability, or death.  

If my camper is experiencing any symptoms related to a communicable disease on the day of attending a Camp 

program, my camper will remain at home and I will contact Camp to see about attending Camp at a later date or to 

cancel their registration.  

 

                           

                 Parent or Guardian Signature                     Date 

 

The health and safety of our campers is our priority. We are doing our best to create a healthy and safe environment 

for everyone on Camp. Thank you for understanding. 

If you have any questions, please contact the Camp office at 260‐636‐7101 or camp@lutherhaven.org. 

 

 

2020 Camper Medical Information/Parental Permission Form Camp Lutherhaven

This form is to be filled out by a parent/guardian of each camper.

1. Name: _______________________________________________ Birth date:____________ Age:______ Sex:_____ Last First Middle Initial

2. Parent(s) or guardian(s): ________________________________________________________________________________ 3. Home address: _________________________________________________________________________________________ Street address City State Zip code

4. Home phone: ( ) Cell phone: ( ) Work phone: ( ) 5. Other emergency contact: _________________________________________________ Phone: ( ) 6. Name of family physician:_________________________________________________ Phone: ( ) 7. Medical insurance carrier:_________________________________________Insurance phone: ( ) Policy or group number:

Medical Information and History

8. If sending ANY medications (prescribed or other) to Camp with your child, complete the chart below. All medication must be sent in its original container and kept with the first aid coordinator, except inhalers and topical creams as prescribed by your physician for self-administration.

Medication

Dosage

Times Given

Reason for Medication

9. Please check which of the following over-the-

counter medications you allow to be given to your child, if necessary.

„ Antacid tablets „ Antihistamine „ Aspirin-free pain reliever „ Cough drops/syrup „ Decongestant „ Topical anti-itch creams/sprays

10. Please list all allergies (Including food or drug.) (If your child’s diet requires special accommodations due to allergies or intolerances, please contact Camp at least 2 weeks in advance.) ______________________________________________________________________________________________________________________________ ____________________________________________________________________________________

11.Please list the date your child received his/her last tetanus shot: _______________ 12. For females only:

Has your daughter menstruated? ________________ If not, has she been told about it?_____________ If so, is her menstrual history normal? __________

Comments:___________________________________ 13. Medical conditions (Check all that apply and include

explanations here and/or at question #14 on back):

„ Heart „ Kidney/Bladder „ Asthma/Lung Disease „ Ear Problems „ Stomach problems „ Frequent infections „ Skin Disorders „ Diabetes

Explanations:

14. Please use this space to share any other health information, behavioral issues, significant fears, or other items that may need special consideration or attention by the Camp Lutherhaven staff:

Parent/Guardian Permission Agreement and

Release for Emergency Medical Treatment

I hereby state this health history is correct so far as I know, and the person herein described has permission to engage in all prescribed camp activities except as noted above.

I give permission for over-the-counter medication only as checked on page one, to be given to the person herein described as needed.

I understand that campers at Lutherhaven are occasionally photographed/videotaped during camp activities and that tastefully selected photos/videos are used to publicly promote the Camp. I agree to permit the use of photos/videotapes containing images of my child for Camp promotional purposes, unless I have marked the box at the end of this statement to specifically deny such permission.

„ Do not use photos/videotapes of my child for future publicity including the memory DVD and Camp Group Photo.

In the event I cannot be reached in an emergency, I hereby grant permission for hospitalization and medical treatment for my child as needed and agree to the medical professional relying upon the above information in rendering their treatment.

X_______________________________________________________________________________________ Parent/guardian’s signature Date

A photocopy of this form may be used for offsite camp programs or day trips. (i.e. Adventure Unlimited, Treetop Village, Discovery Week, Junior Servants)

Camp Lutherhaven A relational ministry in the midst of God’s creation

1596 S. 150 W. Albion, IN 46701-9695 Phone 260.636.7101 Fax 260.636.3032 E-Mail camp@lutherhaven.org Web www.lutherhaven.org