The Lutheran Church of Saint Mark

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______________

Parent/Guardian Signature____________________________________