Our Saviour’s Lutheran Church - Day Camp Registration Form July 7 th – 12 th

2. Our Saviour’s Lutheran Church - Day Camp Registration Form July 7th – 12th Please complete one per child Name__________________________________________ Preferred Name________________________________ Birth Date______________________________________ Age_________ Address_____________________________________________________________________________________________ Parent/Guardian Name____________________________________________ Cell_________________________________ Parent/Guardian Name____________________________________________ Cell_________________________________ Emergency Contact________________________________________________ Cell________________________________ Physician________________________________________________________Phone_______________________________ Insurance Carrier____________________________________Group/Policy Number________________________________ Grade in school 2013-2014___________ Home Church____________________________________________________City_________________________________ Special interests or hobbies______________________________________________________________________________ Any restrictions to physical activities_______________________________________________________________________ Any allergies (food, drugs, insects, etc.)_____________________________________________________________________ List any people and their phone numbers who may pick up your child from Day Camp ___________________________________________________________________________________________________ Emergency Release I will not hold Lutherhill Ministries or Our Saviour’s Lutheran Church and their staffs responsible for any accidents, claims, and/or damages arising from my child’s participation in camp activities. I also give Lutherhill Ministries and Our Saviour’s Lutheran Church permission to use any photography/video of me or my child taken at Day Camp for future promotional materials. Parent/Guardian Signature___________________________________________ Date_______________________________ Please note: Your child should wear play clothes and tennis shoes each day of Day Camp.