Parent/Guardian Name

Address

City

State

Zip

Preferred Phone

Other Phone

Email Address

Can we use this e-mail when we send out the reminder information shortly before the start of camp? Can we use this e-mail when we send out the reminder information shortly before the start of camp? Yes Prefer regular mail

Home Church

Has your child(ren) attended this Day Camp previously? Has your child(ren) attended this Day Camp previously? Yes No

If no, how did you hear about our Camp?

Emergency Contact

Relationship to child(ren)

Emergency Contact Phone

Medical/hospital insurance carrier

Group/Policy Number

Name and Phone Number of Physician

Child 1 Name

DOB

Male Female

Age

Grade in Fall

School

Immunizations current

Drug and/or other allergies and if asthmatic

Any activity restrictions or health-related information for camp personnel

Child 2 Name

DOB

Male Female

Age

Grade in Fall

School

Immunizations current

Drug and/or other allergies and if asthmatic

Any activity restrictions or health-related information for camp personnel

Child 3 Name

DOB

Male Female

Age

Grade in Fall

School

Immunizations current

Drug and/or other allergies and if asthmatic

Any activity restrictions or health-related information for camp personnel

Child 4 Name

DOB

Male Female

Age

Grade in Fall

School

Immunizations current

Drug and/or other allergies and if asthmatic

Any activity restrictions or health-related information for camp personnel

I give my child(ren) permission to participate in all Day Camp activities led by Rainbow Trail Lutheran Camp. I agree that Rainbow Trail will not be held responsible for accidents or persons injured arising there from. I also understand my photo or my child’s photo may be taken for use in camp promotional literature. I waive the right to inspect or approve the photo if used for such purposes. My child(ren) has permission to participate in all camp activities, except as noted. I hereby give permission to the medical personnel selected by the camp staff to order x-rays, routine tests and treatments for the health of my child, and in the event I cannot be reached in an emergency. I hereby give permission to the trained camp staff on site to hospitalize or secure proper treatment (including surgery, injection, and/or anesthesia)

Yes, I would like to receive information about Rainbow Trail Lutheran Camp programs