Lincoln City Day Camp~ Aug. 1-5th From 8:30-4:30

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Camper's Name

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Gender

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Please select one option.

Boy Girl

Date of Birth

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Address

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Email

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This address will receive a confirmation email

Parents Name

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Phone

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Grad in the fall

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Please select one option.

1st 2nd 3rd 4th 5th 6th

Emergency and Medical Info

Emergency Contact

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Emergency Phone

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Allergies

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Please select one option.

No Yes

If yes, please list here:

Medication your child will need to take during camp:

Date of last Tetanus Immunization

Doctor:

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Phone

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Parental Release and Permission

“I, the parent or legal guardian of the above named camper, do hereby give permission to the camp staff to secure medical treatment for my child. I, the parent or legal guardian of the above named camper, do hereby give permission for my child’s picture or likeness to be used for Child Evangelism Fellowship promotion and advertising.” Parents Signature

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Date

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How will your child be getting home?

For the safety of your child we will want to know who is authorized to pick them up:

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Payment

Payment for Day Camp is $25 per child. You may mail in a check or cash to the CEF office @ PO Box 216, Depoe Bay, OR 97341 or do it online: https://www.ceflincolncounty.org/camp.php

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Please select all that apply.

Yes, I have paid online. Yes, I have mailed in my payment. No, I have not paid.

Description

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