VBS

7/8/24 - 7/12/24 9 am - 12 pm | Please fill out this form and click submit.

Campers Name

Gender

Please select one option.

Male Female Prefer not to answer

Age of Camper

Please select one option.

5 6 7 8 9 10

Grade just completed by Camper

Please select one option.

K 1st 2nd 3rd 4th

Parent Guardian Primary Name

Parent Guardian Primary Email

This address will receive a confirmation email

Parent Guardian Primary Phone

Parent Guardian Secondary Name

Parent Guardian Secondary Email

Parent Guardian Secondary Phone

Please list allergies and/or special needs of Camper. If non, please write "None"

Name of person (other than parent or guardian) authorized to pick up child

Phone number of person listed as authorized person 1

Name of person (other than parent or guardian) authorized to pick up child

Phone number of person listed as authorized person 2

Emergency Authorization

I hereby authorize St Stephen Lutheran Church and Stepping Stones Early Childhood Center to obtain medical attention for my child in case of emergency. I agree to cover all expenses incurred and will not hold St Stephen or any of its representatives liable.

Please select all that apply.

I Agree

Media Authorization

I release St Stephen Lutheran Church, Stepping Stones Early Childhood Center and its representatives to use my child's image in video, photograph, and electronic reproduction for hard copy publication and/or website/social media posting of St Stephen Lutheran Church without compensation.

Please select all that apply.

I Agree

Bullying Policy

At St Stephen & Stepping Stones, we love all children. We have a No Tolerance Policy for bullying. Any child found to be bullying (as determined at sole discretion of staff) will be asked to leave summer camp.

Please select all that apply.

I Agree

Description

7/8/24 - 7/12/24 9 am - 12 pm

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VBS

Description

Please Fix the Following