Day Camp 2022 Registration Form

BEYOND!
2022 Day Camp with Camp Lutherhaven
August 1-5, 2022 at Christ the King Lutheran Church
Ages Kindergarten-5th Grade. Cost: $35/student

For more information, please contact Eric Nelson @ (208) 664-9231 or eric@ctkcda.com

Family Information

Parent/Guardian Full Name

Address

This address will receive a confirmation email

Phone

Emergency Contact Name

Emergency Contact Phone

Student(s) Information

Student #1 Name

Student #1 Grade Going Into

Student #1 Birthdate

Student #1 T-Shirt Size (please specify size and whether child/youth or adult)

Student #2 Name

Student #2 Grade Going Into

Student #2 Birthdate

Student #2 T-Shirt Size (please specify size and whether child/youth or adult)

Student #3 Name

Student #3 Grade Going Into

Student #3 Birthdate

Student #3 T-Shirt Size (please specify size and whether child/youth or adult)

Student #4 Name

Student #4 Grade Going Into

Student #4 Birthdate

Student #4 T-Shirt Size (please specify size and whether child/youth or adult)

Student #5 Name

Student #5 Grade Going Into

Student #5 Birthdate

Student #5 T-Shirt Size (please specify size and whether child/youth or adult)

Allergy or Medical Concerns (please specify which student, what the health concern is, and any required medications.)

Authorization for Medical Care and Liability and Photo Release

By completing this electronic form and writing my name below, I give permission to Christ the King Lutheran Church to take whatever emergency measures that are judged necessary for the care and protection of my child while under the supervision of the church.

Christ the King Lutheran Church occasionally has the opportunity to use photos to promote different church activities & programs. Uses might include a display board, church newsletter, church website, press releases, social media, etc. No names of minors will be used on the website, social media, or in press releases. By applying my name below, I give permission for the use of my child’s picture.

Parent/Guardian Full Name as Signature

Signature Date

Payment

Payment ($35/student, please select which option fit your situation)

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Description

August 1-5, 2022

Please complete this form to register your student(s) for our 2022 Day Camp at Christ the King Lutheran Church.

Day Camp 2022 Registration Form

Description

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