DAY CAMP REGISTRATION

June 10-14, 2019
8:30 am – 3:30 pm

Children who will complete Kindergarten through 5^th grade in the Spring of 2019 are eligible to come to Day Camp. This year we plan to provide a Christian camp experience for up to 60 children. Registration is on a first come basis. Your child is not registered until the registration form and a $5.00 donation is returned to the church office. Once the 60 spaces are filled, we will begin a waiting list. All children attending camp must be pre-registered. The camp does not accept drop-ins. If your child is unable to attend, please call the church office at 664-6691 as soon as possible so another child can attend.

Camper Information

Camper

Name	Birth Date	Actions
		Edit Delete
There are no Campers.

Maximum number of campers reached.

Parent Information
Parent/Guardian Name*
First Last
Address*
Street Address City State Zip
Email Address*
Home Phone*
Work Phone*
Cell Phone*
Physician*
Physician's Phone*
Insurance Carrier*
Group/Policy Number*
Home Church*
City*
Approved Pick Up
Name and Phone Numbers of those who may pick up your child at Day Camp:*
First and Last Name Cell Phone Work Phone
Volunteer
Would you like to volunteer as a classroom aid or kitchen helper?
- Yes
Select Days:
- Monday
- Tuesday
- Wednesday
- Thursday
Emergency Release Form
I will not hold Cross Trails Ministry, its staff, or the congregational volunteers responsible for accidents, claims or damages arising from my child’s/children's participation in camp activities. I also give Cross Trails Ministry permission to use any photograph or video of me or my child(ren) taken at Day Camp for future promotional materials for its sites and programs.
How would you like to pay the camp registration fee ($5 per camper).*
- I would like to pay by credit card or PayPal.
- I will bring a check or cash by the church office .
I have read and agree with the statement below.*
- I understand that my camper registration is not complete until this payment is received by the church. I understand that a spot will not be saved for my child until the payment has been received by the church office.
Note: When you submit the form below, you will be taken to a PayPal page, where you can either pay with a major credit card (gray button), or login and pay with your PayPal account (blue button). Once you complete your transaction on PayPal, you will be directed back to the Immanuel Lutheran Church website.
Number of Campers
Registration Cost
Total
$0.00
Signature*
Please use your mouse or finger (if you're on a tablet/touchscreen) to sign your signature below.
Phone
This field is for validation purposes and should be left unchanged.

First and Last Name	Cell Phone	Work Phone

DAY CAMP REGISTRATION

June 10-14, 2019 8:30 am – 3:30 pm

Camper Information

Parent Information

Approved Pick Up

Volunteer

Emergency Release Form

June 10-14, 2019
8:30 am – 3:30 pm