Vacation Bible School

Camper's Name*

Grade Entering in Fall*

Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade

Additional children to register?

Please include their names and the grade they will enter in the fall.

Parent / Guardian Name*

Parent / Guardian Email*

Parent / Guardian Phone*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Emergency Contact Name and Relationship to Child*

Please list an alternative contact in case the primary parent / guardian cannot be reached.

Emergency Contact Phone*

My child has permission to take part in all Day Camp activities led by Rainbow Trail Lutheran Camp (Camp) and the hosting congregation (Church). We agree that the Camp, Church, and their personnel will not be held responsible for accidents arising therefrom. I give Camp and Church personnel permission to seek medical treatment for my child in case of injury or illness. I also given permission for photos, video, and electronic images to be taken of me or my child and used for by the Camp or Church for promotional purposes without compensation, inspection or approval.

Health History Information

Do you carry medical / hospital insurance?*

Yes
No

Carrier:

Group / Policy Number*

Physician Name*

Physician Phone*

Are immunizations current?*

Yes
No

If immunizations are not current, please explain:

Please check any of the following Conditions, Diseases, or Allergies, which have occurred to the camper:

Please explain any of those checked in the space below, and to which child they pertain to if registering more than one camper:

Operations or serious injuries: (please list with dates)

Suggestions, any activity restrictions, or health-related information for camp personnel:

Will your child need to take a medication during Day Camp?*

Yes
No

Please list medication, dosage, frequency:

How did you hear about our program?

Signature of Parent / Guardian*

Please type name.

Date*

Yes, I would like to receive information about Rainbow Trail Lutheran Camp’s Programs!

Week for 2022: August 1 – 5, 2022

Who:

What:

Where:

When:

Daily Camp Schedule:

Cost:

Food:

What to bring:

Program night:

Questions?

Register Today!

2022 Vacation Bible School

Health History Information