* Required Fields
Additional Emergency Contact (If parents/guardians are unavailable)
During Day Camp, how will your child come and leave from the day camp site? CarBikeWalk
The following person(s) is/are permitted to pick up my child from Day Camp:
DO NOT release my child to the following:
Health & Permission Form
List any disability or recurring illness:
Note any activites to be limited:
Specify any dietary concerns:
Include current medications / treatments:
Note all allergies:
Bee stings Aspirin Pencillin Peanuts/Nuts
All medications sent to camp must be in the original containers and give to the Christian Education Coordinator
Release: I hereby give permission for the camper, previously named, to participate in all day camp activities and off-site field trips, except as previously noted. I also consent to the use of any photograph or video recordings of my child or family in future LOMO or ELCA publications.
I understand that every effort will be made to contact me if my child needs emergency medical-surgical treatment. But if it is important to do so, I hereby give my permission to the physician selected by the Camp Staff to secure property treatment, to hospitalize, to order injection, anesthesia, x-ray or surgery for my child as named above. I further authorize the Church Coordinator, or their designee, to administer over the counter drugs and mediations as needed.