In the Spotlight - Youth News and Events
Day Camp 2012 - Summer is almost here and we want to invite you to attend Day Camp this year. Whether you are new or a returning camper, we want you to know what a great time you will have this year. The theme for 2012 is "We've Got Spirit".
When: June 25th-29th Where: Central Lutheran Church Why: Because its Fun! Cost: Free, donations accepted
Day Camp Date: June 25th-29th M-Th 9am- 3pm, Friday 9 am til Noon
Return completed Registration Form to: Central Lutheran 1857 Potter St. Eugene, OR 97403
2012 DAY CAMP REGISTRATION FORM
Camper’s Familiar Name _____________________________________________________________________________________
Grade Completed (as of camp) ______M ( ) F ( ) Birthdate ______________ Age as of camp____
Parent /Guardian Name T-shirt size: (youth sizes) S M L XL _______________________________________________________________________________________
Mailing Address ______________________________City_____________________________________ St _____ Zip ___________
Day Phone ________________Night _______________________ Cell __________________________________
Email Address __________________________
Home Church __________________________ City _______________________________
IN CASE OF EMERGENCY, PLEASE NOTIFY:
Name ______________________________________________
Address _________________________________ City_______________________ St ______ Zip ______________
Day Phone ________________Night ___________________________ Cell _________________
Relationship to camper ____________________________________________________________________
APPROVED DRIVER
Name of Person(s) picking up the child:____________________________________________________________
Phone Number of Approved Driver: _____________________________________________________________
Relationship to Parent and Child:__________________________________________
List days to be picked up:_____________________________________________
My Child has permission to walk home, ride a bike home from Day Camp _____YES _____NO
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Parent/Guardian Signature:____________________________ Date:______________________________________________ I would like to make a monetary donation of : $ ___________
ALLERGIES |
Type of Reaction: Please mark which apply |
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Type of Allergy |
No Yes (please circle) |
Describe/Specify Allergen |
Mild |
Moderate (Swelling or severe rash) |
Severe (Difficulty Breathing) |
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Food |
No Yes |
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Medication |
No Yes |
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Environmental (animal, plant, insect, etc…) |
No Yes |
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Other |
No Yes |
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Does your child have any special needs (behavioral and/or physical) we should know about? _____________________________________________________________________________________
I hereby give informed and expressed consent for my child to take part in all camp activities under supervision, and agree that the Day Camp or Day Camp personnel will not be held responsible for accidents arising there from. I authorize the Day Camp Healthcare Provider and/or designated Day Camp staff/volunteer to provide appropriate treatment to my child for injuries and/or illness. I understand that the information on this form may be released to the appropriate medical personnel in case of medical emergency. I also understand the failure to disclose medical or emotional problems in advance may lead to serious consequences while at Day Camp. Lastly, I verify that everything contained on this form is complete and accurate, to the best of my knowledge.
I also consent to the use of any photograph of my child or family in future Lutherwood publications. *A copy of this form will be shared with Camp Lutherwood Oregon at the end of the Day Camp week.
Parent Guardian Signature _________________________________________________ Date _______________
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Director of Children & Family Ministry: Kari Lee
Pastor of Youth and Family Ministry: Pastor Robyn Eddy
Sunday School Secretary/Treasurer: Sandra Koscho
Preschool & Kindergarten: Michele Rodeen (teacher), Krysten Mayfair (teacher)& Erin Couture (helper)
1st & 2nd Grade: Carolyn Evans & Gaye Haverland (co-teachers)
3rd-5th Grade: John Rowell (teacher) & Paula Jewett
Middlers/Highers: Suzie Johnson & Logan Lee
Subs: Michelle Bremer, Kim Meyers, Ann Brennan, Meg Hamilton,
