Summer Camp 2017 Registration

Fields marked with (*) are required.
Child’s full name (*)
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Grade Completed (*)
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*Additional paperwork will be required for all PK2-PK4 campers
Gender(*)
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Date of Birth(*)
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T-Shirt Size(*)
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Currently Enrolled as Grace Lutheran School Student? Y/N(*)
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Currently a member of Grace Lutheran Church? Y/N(*)
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Home Address(*)
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Doctor's Name(*)
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Doctor's Phone Number(*)
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Dentist Name
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Health Insurance Information(*)
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Does your child take any Medications(*)
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List Medications
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Does your child have Allergies(*)
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List Allergies(*)
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Mother's Full Name
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Mother's Phone
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Mother's Email
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Father's Full Name
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Father's Phone
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Father's Email
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Emergency contacts: Name - phone number(*)
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Authorized Persons for Pick‐Up(*)
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Please check each week (to the best of your knowledge) that your child will be attending(*)

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Week 1 Extended Care Options

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Week 2 Extended Care Options

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Week 3 Extended Care Options

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Week 4 Extended Care Options

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Week 5 Extended Care Options

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Week 6 Extended Care Options

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Week 7 Extended Care Options

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Week 8 Extended Care Options

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Terms: Registration fee is due with the registration form. By submitting your registration through this website, the parent/guardian agrees to pay all camp fees as indicated.
Unpaid fees will result in suspension of camp privileges.
Camp policies and refund information are explained in the camp brochure. By completing this registration form you agree to the policies and fees for summer camp as discussed in the brochure.
I agree to pay all fees in accordance with the above terms.


By enrolling your child in Grace Lutheran Church and School summer camp you agree that any images, photos, videos or media captured that involve your child / children can be used by Grace Lutheran Church and School.
Security(*)
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