Vacation Bible School Sign Up

Vacation Bible School Sign Up, June 19-22, 2017 - 1:00 to 5:00pm
Please submit one for each Camper

* Indicates required field

Child's Name *

First

Last

Gender *

Age and Birthdate *

School Grade in the Fall *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Parent or Guardian Name(s) *

First

Last

Parent or Guardian Phone Number *

Parent or Guardian Email *

Emergency Contact (after primary) *

First

Last

Relationship to Camper *

Emergency Phone Number (after primary) *

Alternate Contact *

First

Last

Relationship to Camper *

Emergency Phone Number *

Family Physician *

First

Last

Physician Phone Number *

Indicate any special physical, dietary or emotional needs here: *

Current Medications *

Authorization by Parent/Guardian: I hereby give my permission for my child to participate in Day Camp and activities planned by the SLM 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.

Type Signature and Date *

Submit

Vacation Bible School Sign Up, June 19-22, 2017 - 1:00 to 5:00pm ​Please submit one for each Camper

Vacation Bible School Sign Up, June 19-22, 2017 - 1:00 to 5:00pm
Please submit one for each Camper