Vasa Day Camp Registration

SKOGSBLOMMAN'S VASA YOUTH DAY CAMP REGISTRATION
Childs Name*
Name for T-shirt*
Age as of 7/28/2025*
Birthdate*

MonthDayYear
Date
Grade in September 2025*
Gender*

MaleFemaleOther
Street Address*
City*
State*
Zip*
Phone Number*
Email address*
example@example.com
Buddy request if possible
Would you be interested in being contacted about other Scandinavian events for your children?*

YesNo
Parents Names (1)*
Parent Cell Number (1)*
Parent Names (2)
Parent Cell Number (2)
Child lives with

Parent 1Parent 2Both ParentsOther
Emergency Contact other than parents or doctor*
Emergency Contact Phone Number*
PERSONS (OTHER THAN PARENT) AUTHORIZED TO PICK UP CHILD:
Person 1 - Full Name
Person 1 - Phone Number (Include Area Code)
Person 1 - Relationship to Child
Person 2 - Full Name
Person 2 - Phone Number (Include Area Code)
Person 2 - Relationship to Child
Childs Physician's Name*
Physician's Full Address*
Physician's Phone Number
Medical Insurance*
Grp*
Subs ID*
Date of last physical exam*

MonthDayYear
Date
Date of last Tetanus Shot*

MonthDayYear
Date
Childs swimming ability*
Child's Limitations and/or Cautions (Medications, allergies, etc)*
Vasa Membership Number*
If you currently do not have a membership number, please indicate such. Membership is required to be completed prior to Vasa Day Camp taking place and can be done directly through vasaparkresort.org.
Questions: Call Vasa Park Resort 425-746-3260

Or Website: http://www.vasaparkresort.org/youthprograms

Or Email: office@vasaparkresort.org

Mailing: Vasa Park Resort 3560 West Lake Sammamish Parkway SE Bellevue, WA 98008

Campers Name*
AUTHORIZATIONS:

I give my permission for my child to participate in all activities as part of the Vasa Youth Day Camp.I hereby give permission that my child may be given emergency treatment by a qualified staff memberof Vasa Youth Day Camp or Vasa Park Resort. I also give my permission for my child to betransported by ambulance, treated by aid car personnel and/or transported to an emergency center fortreatment.In the event that I cannot be contacted, I further consent to the medical, surgical, and hospital care,treatment, and procedures to be performed for my child by a licensed physician or hospital selected bythe Camp Coordinator when deemed necessary or advisable by the physician to safeguard my child’shealth.Photographs of campers may be used for advertising Vasa Youth Day Camp. I give permission forphotographs of my child to be used for this purpose.I understand that I (or another authorized adult) must sign my child in and out of camp daily.I have read and understand the above and have completed the information to the best of my ability.
HOLD HARMLESS AGREEMENT
The undersigned parent/guardian of:
Camper's Name*
does hold VASA YOUTH DAY CAMP harmless for any loss, liability or expense incurred during his/her stay beginning July 28th through August 1st, 2025.
Parent/Guardian Name*
Signature*

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Date*

MonthDayYear
Date
PLEASE INDICATE YOUR CHILD'S TEE SHIRT SIZE
Type a question*

Youth Size Small (6-8)Youth Size Medium (10-12)Youth Size Large (14-16)Youth Size X-Large (18-20)Adult Size SmallAdult Size MediumAdult Size LargeAdult Size X-LargeOther

My Products

Vasa Day Camp Camper (Early Bird Special)Enter description

$230.00 Quantity

Total

$0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Should be Empty:

SKOGSBLOMMAN'S VASA YOUTH DAY CAMP REGISTRATION

PERSONS (OTHER THAN PARENT) AUTHORIZED TO PICK UP CHILD:

HOLD HARMLESS AGREEMENT

PLEASE INDICATE YOUR CHILD'S TEE SHIRT SIZE