True Life Youth Ministries

ELEMENTARY CLUB STEM CAMP

Greetings! Our staff is so happy that you are interested in signing your child/children up for our Elementary Day Camp. This is a 3- day camp in our Lebanon location where we will provide food, fun and an unforgettable experience for your child this summer. This camp is only for kids k-5 (just graduation kindergarten) to 5th grade (just graduated 5th grade). Please read the details below and provide us with your child’s information so that we can reserve their spot!

MEETING PLACE: 1300 W MAPLE ST, LEBANON, PA 17046

DATES: TUESDAY, JUNE 11TH - THURSDAY, JUNE 13TH

ASSEMBLY TIME: 9:30 AM (FOR BREAKFAST) OR 10 AM (REGULAR START TIME)

PICK UP TIME: 2PM

Permission

I am allowing my child (named below) to attend True Life Day Camp from June 11th - 13th 2024:

By writing my name below, I am granting permission for my child to attend True Life Day Camp from June 11th - 13th 2024:

Waivers

I will not hold True Life Youth Ministries liable for any accidents that may occur during the activity.

I am authorizing the supervising adult to take necessary action in case of emergency.

Parent or Gaurdian Full Name

Date

Month

Day

Year

If you have any questions, don't hesitate to contact our Student Life Director Asia Kunarasa at 917-324-4466.

Camper Info

First name

Last name

Address

Birthday

Month

Day

Year

Grade

Emergency Contact #1

Emergency Contact #1 Name

Contact #1 Phone

Emergency Contact #2

Emergency Contact #2 Name

Contact #2 Phone

Medical Insurance Info

The Camper Has Medical Insurance (Y/N)

Yes

No

Medical Insurance Company:

ID:

Group No:

Please list any persons (full names) not permitted to remove or pick up child from camp:

Medical Waiver

IN THE EVENT THAT MY CHILD IS INJURED AND NEEDS MEDICAL CARE, TRUE LIFE HAS MY PERMISSION TO SEE THAT SHE/HE RECEIVES MEDICAL TREATMENT AND I WILL BE DIRECTLY RESPONSIBLE FOR THE PAYMENT OF THAT TREATMENT.

By placing my full name below, I agree to the terms of the listed medical waiver.

Date

Month

Day

Year

Additional Medical Info

Does the camper have any medical conditions that we should be aware of?

Yes

No

If yes, please explain:

Are there any special instructions for this child? (dietary restrictions, forbidden activities, etc...)

Yes

No

If yes, please explain:

Any allergies?

Yes

No

If yes, please explain:

Any prescription medications that the child will need to take while at camp?

Yes

No

If yes, please note name, amount/dose, and time that it needs to be administered:

My child needs transportation to/from True Life Day Camp.

Yes

No