Date & Time
June 10, 2024 9:00 AM - 3:00 PM
15 out of 50 remaining tickets available
Type
Price
Quantity
SRLC Day Camp Registration
15 Remaining
Price
$50.00
Quantity
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SRLC Day Camp Registration
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2024 SRLC Day Camp Registration
Please complete all required fields.
Camper Information
Camper's First Name
*
Camper's Last Name
*
Grade Entering in the Fall
*
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
Camper's Preferred Name
*
Date of Birth
*
Gender
*
Home Address
*
Home City
*
Home State
*
Home Zip Code
*
Camper's Health/Medical Information
Do you carry medical insurance?
*
Yes
No
Insurance Carrier
*
Group/Policy Number
*
Physician's Name
*
Physician's Phone #
*
Are your child's immunizations up to date?
*
Yes
No
Conditions/Diseases to be aware of
Dietary Restrictions/Allergies
*
Does camper carry an Epi-pen?
Yes
No
Any Other Health & Wellness Concerns
Parent/Guardian Contact Information
Parent/Guardian #1
*
Preferred Phone #
*
Primary Email Address
*
Parent/Guardian #2
Preferred Phone #
Secondary Email Address
Emergency Contact Information (if different than above)
Emergency Contact Person
Emergency Contact Relationship
Emergency Contact Phone #
Permissions
I am the lawful adult parent or guardian of above child.
*
Yes
No
My Child has permission to take part in all Day Camp activities led by Sky Ranch Lutheran Camp (Camp) and hosted by Joy Lutheran Church (Church). I agree that the Camp, Church, and their personnel will not be held responsible for accidents arising therefrom. I give Camp and Church personnel permission to seek medical treatment for my child in case of injury or illness. I also given permission for photos, video, and electronic images to be taken of me or my child and used for by the Camp or Church for promotional purposes without compensation, inspection or approval.
*
Yes
No
