Day Camp 2024 Registration Form

TOGETHER!
2024 Day Camp with Camp Lutherhaven
July 29-August 2, 2024 at Christ the King Lutheran Church
Ages Kindergarten-5th Grade. Cost: $40/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

Home Congregation (if none, please type "none")

Phone (Where you can be reached in the event of an emergency)

Emergency Contact Name (Besides custodial parent(s)/guardian(s))

Emergency Relationship to Family

Emergency Contact Phone

Camper(s) Information

Camper #1 Name

Camper #1 Address (if different from above)

Camper #1 Grade Going Into

Camper #1 Birthdate

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

Camper #2 Name

Camper #2 Address (if different from above)

Camper #2 Grade Going Into

Camper #2 Birthdate

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

Camper #3 Name

Camper #2 Address (if different from above)

Camper #3 Grade Going Into

Camper #3 Birthdate

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

Camper #4 Name

Camper #4 Address (if different from above)

Camper #4 Grade Going Into

Camper #4 Birthdate

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

Camper #5 Name

Camper #5 Address (if different from above)

Camper #5 Grade Going Into

Camper #5 Birthdate

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

Allergy or Medical Concerns (please specify which camper, what the health concern is, including any allergies to medication or food, and any medications being taken, even if administered at home.)

Family Physician

Physician Phone Number

Medical Insurance Company

Insurance ID number

Name of Primary on the Insurance Plan

Description of any limitations or restrictions on camp activities

Release of Camper to Non-Parent or Guardian

Please fill out this section of the form if someone other than the custodial parent or guardian listed in this registration is to be picking the child up at the end of the camp day.

Camper(s) Name(s)

Parent/Guardian's Name

Name of person(s) picking up the camper

Relationship to the camper

List day(s) to be picked up

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 and Lutherhaven Ministries 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 ($40/student, please select which option fit your situation)

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Description

July 29 - August 2, 2023

Please complete this form to register your student(s) for our 2024 Lutherhaven Day Camp at Christ the King Lutheran Church.

Day Camp 2024 Registration Form

Description

Please Fix the Following