2009
ZION DAY CAMP REGISTRATION
August 3 to 7
(9:00 a.m. - 3:00 p.m. Enter grade 1-grade 6)
(9:00 a.m. - 11:00 a.m. Preschool)
Use the "tab" key to advance to the next box. When finished and you are
satisfied with the form click the "Send Form" button. If you wish to make
corrections put the cursur at the correction point. If you wish to start over
click on the "Start Over" button.
PRE-SCHOOL
DAY CAMP
$15.00
Click in box to right
OR
K-6
DAY CAMP
$25.00
Click in box to right
Please list people and their phone numbers who you agree may pick up your child. (1) (2) (3)
For your child's safety, they need to be picked up in the
social hall. Please find your child's counselor and notify
them when you pick up your child.
Select only one of the following two choices. Payment
must be at the church by August 4, 2008.
Click the box to the left if you will bring it to the church before Aug 4
Click the box to the left if you will send it to the church before Aug 4
Voyageurs Lutheran Ministry
Day Camp Health Health Form
INOCULATION RECORDS
Check the appropriate boxes, "tab" and give approximate date.
HEALTH HISTORY
Check the appropriate boxes and give approximate dates for any instances.
Restrictions:
PARENTS/GUARDIAN AUTHORIZATION: - This health history is current as far as I know, and the person
herein described has permission to engage in all prescribed camp activities (both on and off site),
except as noted on this form. I give Voyageurs Lutheran Ministry (VLM) staff permission to administer
any minor first aid and any prescription medication that is listed on this form, following the directions
listed. In the event of an emergency, I give permission to the physician selected by the Camp Director
to give the necessary medical treatment for my child.
I also agree that my photo or my child's photo may be used for VLM's promotional publications or
videos. I waive the right to inspect or approve photos or footage if used for such purposes.
