2026 VBS/ Day Camp Registration Form June 28-July 2

Day Camp is for Students Entering First Grade through Sixth Grade.

Camper Name

Birthdate

Grade Completed

Address

Parent Email

This address will receive a confirmation email

Parent Mobile Phone

Emergency Contact Name

Emergency Contact Phone Number

Medical Insurance Carrier

Medical Insurance Policy Number

Does the camper take any daily medications?

No Yes (if yes, complete below:)

Name of Drug/Time of Administration/Dosage

Does the camper have any medical conditions (i.e., allergies, asthma, diabetic) that the church or FLLC staff should be aware of?

Medical Conditions

I hereby grant permission for this camper to participate in all Day Camp activities including off-site events. I retain the responsiblity for any and all bodily injury, loss, or damage of personal property. I hereby authorize the church to consent to emergency medical or surgical treatment and to routine, nonsurgical medical care for this camper while attending the Day Camp program.

Check Box

Parent/Guardian Electronic Signature:

Date

I grant permission for MUMC/FLC/FLLC to use photos, videos, or other likeness of the above camper for publicity in print or digital form, including the use of social media such as, but not limited to, Facebook, Instagram, and X. MUMC/FLC/FLLC will not include any identifying information about your camper.

Check Box

Parent/Guardian Signature

Date

Join the Counselors at First Lutheran Church for Ecumenical Worship and a Potluck on June 28th to kick off Day Camp week.

Day Camp is from 9:00 am to 3:00 pm Monday through Thursday.

Bring a Water Bottle and a Sack Lunch!!

On July 2, 2026, at 3:00 pm, there will be a closing program and an ice cream social.

Description

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2026 VBS/ Day Camp Registration Form June 28-July 2

Description

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