2024 Vacation Bible Day Camp

Rainbow Trail Lutheran Camp 2024 Day Camp

*This form needs to be completely filled out by a parent/guardian. It will be kept by the Church staff
* The cost is $10 per camper. This covers a T- shirt, snacks, and craft supplies.
Pay here $10 fee

Camper Name:

Email:

This address will receive a confirmation email

Phone:

Birthdate:

Address:

Parent/Guardian:

Phone:

Parent/Guardian

Phone:

Emergency Contact:

Relationship with the camper:

Phone:

Do you carry medical/hospital insurance?

Yes No

If so, please indicate:

Carrier

Group/policy number

Name of Physician

Phone:

Date of last immunization for: Tetanus ______; DPT ______; Polio ______; Measles (MMR)______

Please check and date any of the following, which have occurred to the camper or in the camper's family:

Please explain any those checked in the space below:

Operations or serious injuries: (please list with dates)

Suggestions, any activity restrictions, or health-related information for camp personnel:

Will your child need to take medication during Day Camp?

If you answered yes to the question above, please list the medication.

My child has permission to participate in all camp activities, except as noted. I hereby give permission to the medical personnel selected by the camp director to order X-rays, routine tests and treatment for the health of my child. In the event I cannot be reached in an emergency, I hereby give permission to the physician selected by the camp director to hospitalize or secure proper treatment (including surgery, injection, and/or anesthesia) for my child as named above.

I hereby autorize the capture of photos and/or video of my child during the camp, for the purpose of their potencial use on our website and social media plataforms.

Parent/Guardian Consent

2024 Vacation Bible Day Camp

Description

Please Fix the Following