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Vacation Bible School Sign Up,
Please submit one for each Camper.
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Indicates required field
Child's Name
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First
Last
Gender
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Age and Birthdate
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School Grade in the Fall
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Address
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Line 1
Line 2
City
State
Zip Code
Country
Parent or Guardian Name(s)
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First
Last
Parent or Guardian Phone Number
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Parent or Guardian Email
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Emergency Contact (after primary)
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First
Last
Relationship to Camper
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Emergency Phone Number (after primary)
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Alternate Contact
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First
Last
Relationship to Camper
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Emergency Phone Number
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Family Physician
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First
Last
Physician Phone Number
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Indicate any special physical, dietary or emotional needs here:
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Current Medications
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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
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