Day Camp 2013

June 10-14
St. Paul Lutheran Church (ELCA) Borchers
10792 N County Road 210 E
Seymour, IN 47274
Phone: (812) 522-7364 or (812)522-7484 email: stpaullutheran@stpaul-borchers.org

Camp will meet daily Monday through Friday. Activities will include Bible Study, worship, games, songs, snacks, arts &
crafts, stories, and drama. Children will need to bring a sack lunch each day.
Preschool and Kindergarten (ages 2-5; not yet started kindergarten):
9:30 a.m. 11:30 a.m.
Grades 1-6 (Entering in fall13)
9:30 a.m. - 2:30 p.m.
Special afternoon events Tuesday-Thursday begin around 3:00 p.m.

Day Camp 2013- Registration Form

Name ________________________________________

Birth date ________________________

Address ______________________________________

Grade Next Fall: 1st

City ___________________ State_______ Zip__________

Preschool class preferred: 2yr

Youth Helper

7th

2nd 3rd 4th 5th 6th

8th

9th

3yr 4yr Kdg

10th Over

(Please choose one) Helping with: Preschool

Parents/Guardians _______________________________________
Home Phone ____________________________
Cell Phone ______________________________ Work Phone_____________________________
Person to Contact First if needed during day camp hours ___________________________
Phone Number __________________________________
Day Camp T-shirt size:

Youth XS(2-4)
Adult S

Youth S (6-8)
L

XL

Youth M (10-12)
XXL

Youth L (14-16)

XXXL

Name of church you attend: __________________________________ City _________________________

-Over-

1st -6th

DAYCAMP 2013 MEDICAL RELEASE

I/we, ___________________________________________________ as parent(s) or guardians
of ________________________________________________________ (childs Name)
delegate my / our legal authority to consent to healthcare on behalf of such child to St. Paul
Lutheran church (Borchers). This delegation is to be exercise to good faith and in the best
interest of my/our child. This delegation is effective June 10, 2013 up to and including June
14, 2013
Signature of Parent(s): _________________________________Date _________________

MEDICAL INFORMATION
Childs Name: __________________________________________________
Allergies _______________________________________________________
Present Medications: ____________________________________________
Any Medical condition(s) physician should know about: ____________________________________________________
_________________________________________________________________________________________________

Please note the attached sheet of afternoon events. To

encourage family time, we are asking that an adult be
present for your child beginning at the evening meal.
An adult, responsible for your child, must be present at the pool
for them to participate.
Transportation will be provided Tuesday-Thursday to the afternoon event. If your
child is going in the afternoon please let the person signing them in know
Photographs may be taken of you child for use on our website. If you have a
concern with this please talk to one of the directors or the pastor.