Camp Trinity Registration 2015
*Must have completed Kindergarten-7th Grade
Child’s Name ______Age ______
Grade Completed ______Child’s Birthdate ______Gender ______
Child’s Address ______
City/State/Zip ______Home Phone ______
Name and Ages of Brothers and Sisters attending Camp Trinity ______
Child primarily lives with: (circle) BOTH PARENTS MOM DAD
T-shirt Size (circle): YOUTH: S M L XL
ADULT: S M L XL XXL
** FIRST shirt is included in the $100 registration fee.
If you would like to purchase a 2nd child’s shirt, fill out this information.
COST: $10
SECOND T-shirt Size (circle): YOUTH: S M L XL
ADULT: S M L XL XXL
Mother’s NameAddress
City/State/Zip
Cell Phone
Email Address
Name of Employer
Father’s Name
Address
City/State/Zip
Cell Phone
Email Address
Name of Employer
Does your child have any allergies, health or other problems that we should be aware of? Please indicate below (Medications that need to be administered on campus require a separate form to be completed by a parent.)
______
______
Emergency Contact Person, Relationship & Phone Number: ______
______
Other Helpful Information: ______
Who may pick up your child, other than the parents? Please list below.
Name ______Relationship ______
Address ______
______
Phone ______
Name ______Relationship ______
Address ______
______
Phone ______
Name ______Relationship ______
Address ______
______
Phone ______
A copy of the legal document, verifying custody and visitation rights, must be submitted if parents are legally separated or divorced.
Comments and/or Concerns: ______
______
______
______
______
______
Rates for Camp Trinity 2015
$100 Registration Fee ($75 if paid by May 1, 2015) This registration fee is the same for all campers regardless of number of days attending camp.
1 full week of camp (4-5 full days): $180 Camp Hours: 7 a.m. – 6 P.M.
1 partial week of camp (1-3 full days): $130
Weekly fees include all field trips and activities (with the exception of Medieval Times), daily hot lunch, and two snacks.
No daily drop in rate.
SIBLING RATE: 20 % discount ($142 per 4-5 day week) No Drop-In Fee or Partial Week Discount Available
Please select the week(s) below that your camper will attend.
_____ June 8-12 “My Creation”
_____ June 15-19 “Wild and Wacky Games”
_____ June 22-26 “Ninja Turtles” (Black Belts for Christ)
_____ June 29-July 2 “Magic of Color”*
_____ July 6-10 “Planes, Trains, and Automobiles”
_____ July 13-17 “Holiday Extravaganza”
_____ July 20-24 “Legos Lalapalooza”
_____ July 27-31 “Building Bridges with Becky”
_____ August 3-7 “Make a Joyful Noise”
_____ August 10-14 “In the Steps of Jesus”
* Camp will be closed on Friday, July 3th
CAMP TRINITY WILL BE CLOSED THE WEEK OF AUGUST 17-21ST
· I UNDERSTAND THAT THE REGISTRATION FEE OF $100.00 MUST ACCOMPANY THIS APPLICATION AND IS NON-REFUNDABLE (CHECK OR CASH).
· I UNDERSTAND THAT I MUST SUBIT A COMPLETED SELECTION OF CAMPS ON THIS FORM BEFORE MY CHILD WILL BE ACCEPTED INTO CAMP TRINITY.
· I AGREE TO HAVE MY CHILD’S WEEKLY FEE DEDUCTED FROM THE ACCOUNT OF MY CHOICE THE FRIDAY BEFORE MY CHILD ATTENDS UNLESS I E-MAIL BY 5:00 P.M. THE THURSDAY PRIOR TO THE WEEK MY CHILD IS SIGNED UP TO ATTEND. IF THAT PAYMENT DOES NOT CLEAR BY TUESDAY OF THE WEEK OF CAMP, I WILL BRING IN A CASH PAYMENT IN ORDER FOR MY CHILD TO CONTINUE ATTENDING CAMP THAT WEEK.
· I AGREE TO PICK UP MY CHILD AS CLOSE TO 6:00 P.M. AS MY WORK SCHEDULE ALLOWS.
· I GIVE CAMP TRINITY PERMISSION TO TAKE MY CHILD TO ______HOSPITAL, OR THE NEAREST HOSPITAL IN THE EVENT OF AN EMERGENCY; AT THE EXPENSE OF THE CHILD’S FAMILY SHOULD EMERGENCY CONTACTS NOT BE REACHED.
· I GIVE PERMISSION FOR MY CHILD TO PARTICIPATE IN SCHOOL/CHURCH ACTIVITIES ANYWHERE ON THE PROPERTY OF TRINITY LUTHERAN CHURCH AND SCHOOL.
· I ALSO UNDERSTAND THAT I MUST SIGN MY CHILD IN UPON DROP OFF AND OUT UPON PICK UP, EACH DAY.
· I give permission for my child to participate in all scheduled activities. In consideration of the permission granted for my child to attend and participate in scheduled activities, I hereby release and discharge Trinity Lutheran Church and School, its agents, employees and officers from all claims, demands, actions, judgments and executions which the undersigned’s heirs, executers, administrators and assigns may have or claim to have against it’s successors or assigns to all personal injuries known or unknown, and injuries to property caused by or arising out of the above described attendance and activities.
· I also hereby give permission to the Trinity Lutheran Church and School staff to act in a medical emergency situation and for appropriate medical staff to administer emergency medical treatment to my child.
Signature of Parent/Guardian _
Signature of Parent/Guardian ______Date ______
Please tell us how you heard about CampTrinity:______