Registration & Health Info - Faith Lutheran Church Day Camp 2026

Please complete BOTH forms:
(1) the REGISTRATION & HEALTH INFO (entered digitally here using JotForm), and
(2) the CONSENT AND RELEASE which must be printed out and physically signed.
If you prefer, paper forms are available from the Office.

PLEASE COMPLETE THE REGISTRATION & HEALTH INFO below.
Registration & Health Info - Faith Lutheran Church Day Camp 2026

Please fill out the following registration and health information:
Participant's Role
Staff Role
Participant's Full Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Age as of June 15, 2026
M/F
Grade participant will enter in the Fall
Does the participant attend church?
If so, where?
Participant's Home Address
Parent/Guardian or Adult Helper Name

First NameLast Name
Best Daytime Phone
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian Phone Type
Alternate Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Alternate Phone Type
Parent/Guardian Home Address (if different from participant)
Parent/Guardian Email Address
example@example.com
Emergency Contact Name

First NameLast Name
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Relationship to Participant
Authorized Pickup Persons (other than parent/guardian)
Does the participant have any allergies?
If yes, please list allergies and describe reactions.
Does the participant have any medical conditions or take medications?
If yes, please describe medical conditions and medications.
Does the participant have any restrictions?
If yes, please explain any activity restrictions (i.e. what cannot be done, & what adaptations or limitations are necessary)
Additional information about the participant’s behavior and physical, emotional or mental health about which the Day Camp staff should be aware.
Health Insurance Provider
Policy Holder Name

First NameLast Name
Policy Number
REMINDER: A physical signed copy of the CONSENT AND RELEASE is mandatory for camp attendance.
Should be Empty: