Camp Calumet at St. Mark Registration Form
(one Form for each child registering please)
Child’s Name:______________________________ Child’s Age_______
Last School Grade completed______
Parent/Guardian Name________________________________________
Address___________________________________________________
Home telephone:____________________ Cell phone:_______________
Home email address:_________________________________________
In Case of Emergency (when parent/guardian cannot be reached) Contact:
Name_____________________________ Phone__________________
Relationship to child:_________________________________________
Please list any allergies (including food) the VBS staff should be aware of
________________________________________________________
Person Responsible for picking up this child at the end of each VBS day:
Name________________________________ Phone______________
Name________________________________ Phone______________
Parent/Guardian Signature____________________________________
“in joy we share Christ’s truth”
75 Griswold Street, Glastonbury, CT
860-633-1188
The Lutheran Church of Saint Mark