2025 Participant Vacation Bible School Registration Form

This year, Faith Lutheran Church will be partnering with Lutherdale Camp to host VBS!

June 23-27, 2025
Kindergarten-7th Grade 9a - 3p Monday - Thursday; 9a - 12:30p Friday
Preschool 9a - 12:30p Monday - Friday (children must be potty trained)
$100 for Full Day / $40 for Half Day

Registration Opens February 1 for members and March 1 for the Community.

If you have any questions, please contact Deacon Kayla at kfeil@faithonline.org

Parent / Guardian Information

Parent/ Guardian 1 Information

Parent / Guardian 1 Name

Gender

Do participant(s) live with Guardian 1?

Relationship to Participant(s)

This address will receive a confirmation email

I want to receive monthly email updates on Faith Lutheran's Children's Ministry Opportunities

Yes No

I want to be added to Lutherdale's mailing list (spring & fall newsletter, summer camp info)

Yes No

I want to receive monthly email updates on current programs and events at Lutherdale

Yes No

Parent / Guardian 2 Information

Parent / Guardian 2 First Name

Parent / Guardian 2 Last Name

Gender

Do Participant(s) Live with Guardian 2?

Relationship to Participant

Permanent Address if Different Than One Listed Above

I want to receive monthly email updates on Faith Lutheran's Children's Ministry Opportunities Yes No

I want to be added to Lutherdale's mailing list (spring & fall newsletter, summer camp info) Yes No

I want to receive monthly email updates on current programs & events at Lutherdale Yes No

Emergency Contact Information

Emergency Contact Name Other Than Parent/Guardian Listed Above (First, Last)

Gender

Relationship to Participant

VBS Sign Out Authorization For All Participants

Only the following adults (18 years of age) are authorized to sign out and pick up my camper(s) from VBS. Include yourself, if applicable. Campers will only be released to authorized adults below. Include three adults - list first/last names, relationship to camper(s) and phone numbers.

Will your camper(s) need to be picked up early? If yes, please list dates and times.

Will your camper(s) return to VBS after being picked up early? If yes, please list dates and times below.

The following adults are NOT allowed to pick up my camper(s)

Releases and Authorization

Media Release: I giver permission for photographs and/or video images of my camper to be used in future Lutherdale and Faith Lutheran promotional materials (print publications, website, and social media). Lutherdal and Faith Lutheran will not include names or identifying information to any pictures of participants posted in our promotional materials without direct contact and written documentation or permission on file. PLEASE NOTE: If you do not agree to this release, Lutherdale and Faith will not take ANY pictures of your camper during summer camp, this includes cabin group photos

Yes No

Liability Release: In consideration of acceptance to Lutherdale Bible Camp, and Faith Lutheran's VBS, I indemnify and hold harmless Lutherdale Bible Camp and Faith Lutheran Church, its owners, agents, associates, and staff from any and all liability, claims, damage, injury, exposure to contagious conditions such as COVID-19, or illness sustained by my camper.

Yes No

Exposure Notification: I will notify the Camp Office (262) 742-2352 if I become aware that my camper was exposed to or may have contracted a contagious condition prior to the program or up to 7 days after departing Lutherdale / VBS

Yes No

Parental Authorization: In case of a medical emergency, I understand every effort will be made to contact the guardians of the camper. In the event that I cannot be reached, I hereby give permission to the medical examiner selected by the church staff to hospitalize, to secure proper treatment for, to order injection, anesthesia, or surgery for my child as named on this form.

Yes No

Participant One General Information

Participant First Name

Participant Last Name

Gender

Grade Completed as of June

Participant Congregation & City

T-Shirt Size

Does your child have a friend attending? Please name below.

Participant One Health Information

Does your camper have any health conditions we should be aware of?

Yes No

If yes, please check all that apply: Ear Infections Asthma Heart Disease or Heart Defect Measles Seizures Chicken Pox Diabetes German Measles Bleeding or Clotting Disorder Mumps Hypertension Hepatitis Mononucleosis

Other Health Conditions We Should Be Aware of

Please give approximate dates for the above conditions / elaborate on the "other" option

Please check boxes below if your camper's immunizations are current or up to date.

Covid-19 Polio Immunization Covid-19 Booster TD (tetanus/diphtheria) DPT Permanent Shots MMR (Measles, Mups, Rubella)

Tetanus Booster Dates

Hepatits B Tuberculosis Test

Does your camper have any chronic or recurring illnesses or medical conditions that may impact their time at VBS? If so, please explain below.

Does your camper have any activity restrictions due to health conditions? If yes, please explain below.

Are there any social or emotional needs that we need to be aware if? If so, please explain.

Suggestions that may make the camper's experience at VBS successful and enjoyable (fears, anxieties, current family situations, etc). How can we respond as a camp staff to help your camper?

Does your camper have any allergies? Please list below. Include environmental, food, and medicine allergies.

Will your camper be bringing any medications to VBS? If so, please list name of medication(s), dose and time(s) given below.

Participant Two General Information

If you do not have a second participant, please scroll down to bottom to complete registration with one final signature.

Participant First Name

Participant Last Name

Gender Male Female Nonbinary

Grade Completed as of June Preschool Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade 6th Grade

Participant Congregation & City

T-Shirt Size Youth Extra Small Youth Small Youth Medium Youth Large Youth X Large Adult Small Adult Medium Adult Large

Does your child have a friend attending? Please name below.

Participant Two Health Information

Does your camper have any health conditions we should be aware of? Yes No

Other health conditions we should be aware of:

Please give approximate dates for the above conditions / elaborate on the

Please check boxes below if your camper's immunizations are current or up to date. Covid-19 Polio Immunization Covid-19 Booster TD (tetanus/diphtheria) DPT Permanent Shots MMR (Measles, Mumps, Rubella)

Tetanus Booster Dates

Hepatitis B Tuberculosis Test Positive Negative

Does your camper have any chronic or recurring illnesses or medical conditions that may impact their time at VBS? If so, please explain.

Does your camper have any activity restrictions due to health conditions? If yes, please explain.

Are there any social or emotional needs that we need to be aware of? If so, please explain.

Suggestions that may make the camper's experience at VBS successful and enjoyable (fears, anxieties, current family situations, etc). How can we respond as a camp staff to help your camper?

Does you camper have any allergies? Please list below. Include environmental, food, and medicine allergies.

Will your camper be bringing any medications to VBS? If so, please list name of medication(s), dose and time(s) given below.

Participant Three General Information

If you do not have a third participant, please scroll down to bottom to complete registration with one final signature.

Participant First Name

Participant Last Name

Gender Male Female Non-binary

Grade Completed as of June Preschool Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade 6th Grade

Participant Congregation & City

T-Shirt Size Youth Extra Small Youth Small Youth Medium Youth Large Youth X Large Adult Small Adult Medium Adult Large

Does you child have a friend attending? Please name below.

Participant Three Health Information

Does your camper have any health conditions we should be aware of? Yes No

If yes, please check all that apply. Ear Infections Asthma Heart Disease or Heart Defect Measles Seizures Chicken Pox Diabetes German Measles Bleeding or Clotting Disorder Mumps Hypertension Hepatitis Mononucleosis

Other health conditions we should be aware of

Please give approximate dates for the above conditions / elaborate on the

Please check boxes below if your camper's immunizations are current or up to date Covid-19 Polio Immunization Covid-19 Booster TD (tetanus/diphtheria) DPT Permanent Shots MMR (Measles, Mumps, Rubella)

Tetanus Booster Date

Hepatitis B Tuberculosis Test Positive Negative

Does your camper have any chronic or recurring illnesses or medical conditions that may impact their time at VBS? If so, please explain below.

Does your camper have any activity restrictions due to health conditions? If yes, please explain below.

Are there any social or emotional needs that we need to be aware of? If so, please explain.

Suggestions that may make the camper's experience at VBS successful and enjoyable (fears, anxieties, current family situations, etc). How can we respond as a camp staff to help your camper?

Does your camper have any allergies? Please list below. Include environmental, food, and medicine allergies.

Will your camper be bringing any medications to VBS? If so, please list name of medication(s), dose and times given below.

Participant Four General Information

If you do not have a fourth participant, please scroll down to bottom to complete registration with one final signature.

Participant First Name

Participant Last Name

Gender Male Female Non-binary

Grade Completed as of June Preschool Kindergartn 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade 6th Grade

Participant Congregation & City

T-Shirt Size Youth Extra Small Youth Small Youth Medium Youth Large Youth X Large Adult Small Adult Medium Adult Large

Does your child have a friend attending? Please name below.

Participant Four Health Information

Does your camper have any health conditions we should be aware of? Yes No

If yes, please check all that apply: Ear Infections Asthma Heat Disease or Heart Defect Measles Seizures Chicken Pox Diabetes German Measles Bleeding or Clotting Disorder Mumps Hypertension Hepatitis Mononucleosis

Other health conditions we should be aware of

Please give approximate dates for the above conditions / elaborate on the "other" option

Tetanus Booster Dates

Hepatitus B Tuberculosis Test Positive Negative

Does your camper have any chronic or recurring illnesses or medical conditions that may impact their time at VBS? If so, please explain below.

Does your camper have any activity restrictions due to health conditions? If yes, please explain below.

Are there any social or emotional needs that we need to be aware of? If so, please explain.

Suggestions that may make the camper's experience at VBS successful and enjoyable (fears, anxieties, current family situations, etc). How can we respond as a camp staff to help your camper?

Does your camper have any allergies? Please list below. Include environmental, food, and medicine allergies.

Will your camper be bringing any medications to VBS? If so, please list name of medication(s), dose and time(s) given below.

By electronically signing this document, I certify that the above statements are true and correct to the best of my knowledge (First Name, Last Name)

2025 Participant Vacation Bible School Registration Form

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