2021 RTLC Day Camp
Date
June 28, 2021 - July 2, 2021
6 out of 50 remaining tickets available
Type
Price
Quantity
2021 RTLC Day Camper
6 Remaining
Price
$55.00
Quantity
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2021 RTLC Day Camper
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2021 RTLC Day Camp Registration
Please complete all required fields.
Camper Information
Camper's Last Name
*
Camper's First Name
*
Grade Entering in the Fall
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Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
Camper's Preferred Name
*
Date of Birth
Gender
*
Home Address
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Home City
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Home Zip Code
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Home State
*
Parent/Guardian Contact Information
Parent/Guardian #1
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Preferred Phone #
*
Primary Email Address
*
Parent/Guardian #2
Preferred Phone #
Secondary Email Address
Emergency Contact Information
Emergency Contact Person
*
Emergency Contact Relationship
*
Emergency Contact Phone #
*
Camper's Health/Medical Information
Do you carry medical insurance?
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Yes
No
Insurance Carrier
*
Group/Policy Number
*
Physician's Name
*
Physician's Phone #
*
Are your child's immunizations up to date?
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Yes
No
Health History Information
Conditions/Diseases to be aware of
*
Dietary Restrictions/Allergies
*
Any Other Health & Wellness Concerns
*
Our Child has permission to take part in all Day Camp activities led by Rainbow Trail Lutheran Camp (Camp) and the hosting congregation (Church). We 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