Vacation Bible School - Augustana Lutheran Church, Denver, CO

Vacation Bible School/Day Camp

Kids entering Kindergarten through 5th grade in fall 2023 are invited to join staff from Sky Ranch Lutheran Camp, July 10–13, 2023, 9 a.m.–4 p.m., each day for music, games, worship, Bible stories, crafts and more! Cost will be $75 per person with a $150 family maximum. Registrations are capped at 40 participants.

Vacation Bible School Registration

(Please complete and submit the participant health form too.)

Date
MM slash DD slash YYYY
Child Information
Child's Name*
First Last
Child's Age*
Child's Gender*
Date of Birth*
MM slash DD slash YYYY
Last School Grade Completed*
Would you like to add another child?*
- Yes
- No
Child's Name*
First Last
Child's Age*
Child's Gender*
Date of Birth*
MM slash DD slash YYYY
Last School Grade Completed*
Would you like to add one more child?*
- Yes
- No
Child's Name*
First Last
Child's Age*
Child's Gender*
Date of Birth*
MM slash DD slash YYYY
Last School Grade Completed*
Parent Information
Name of Parent or Guardian*
First Last
Name of Parent or Guardian 2
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Home Phone*
Parent/Guardian Cell Phone*
Parent Email*
Emergency Contact*
First Last
Emergency Contact Best Phone*
Relationship to Child*
Photo Release*
- Photo Release: I give Augustana Lutheran Church permission to use ministry photos of my child on Facebook, on Augustana’s website, or in Augustana’s publications as long as my child’s name is not publicized.
Health Form and Payment
Upon submitting your registration form, you will be redirected to Augustana's online giving page for payment. Then, please return to our Vacation Bible School page to complete and submit the online Health Form below for your child(ren). Thank you!
Name
This field is for validation purposes and should be left unchanged.

Participant Health Form

Parent Information
First Last
Parent Email
Name
First Last
Birthdate*
MM slash DD slash YYYY
Age
Grade
Gender
Health Insurance Carrier
Health Insurance Group/Policy Number
Health History
Chronic Concerns
Choose all that apply.
Please explain each item checked:
Mental/Emotional Health
Choose all that apply.
Please explain each item checked:
Dietary Concerns
Choose all that apply.
Please explain each item checked.
Allergies
Choose all that apply.
Please describe allergen, reaction, and treatment. Attach more information as needed. If participant carries an EpiPen, please complete the EpiPen Action Plan.
Please describe allergen, reaction, and treatment. Attach more information as needed. If participant carries an EpiPen, please complete the EpiPen Action Plan.
Medications
Please complete the form with all medications (prescription, over-the-counter, vitamins) that will be brought to Augustana’s event(s). Ensure that dosages and instructions are accurate.
Medication #1 Name
(exact name)
Medication #1 Dosage
(mg/ml & tab/capsule)
Medication #1 Administration
Medication #1 Reason for Giving/Notes/Other Instructions
Medication #2 Name
(exact name)
Medication #2 Dosage
(mg/ml & tab/capsule)
Medication #2 Administration
Medication #2 Reason for Giving/Notes/Other Instructions
Medication #3 Name
(exact name)
Medication #3 Dosage
(mg/ml & tab/capsule)
Medication #3 Administration
Medication #3 Reason for Giving/Notes/Other Instructions
Medication #4 Name
(exact name)
Medication #4 Dosage
(mg/ml & tab/capsule)
Medication #4 Administration
Medication #4 Reason for Giving/Notes/Other Instructions
Stocked Over-the-Counter Medications
The following medications may be stocked. These medications are administered by our volunteer adult leader. Please choose any medications that SHOULD NOT BE GIVEN.
Parent/Guardian Release
I approve the over-the-counter medications above for use as needed by the participant. I have crossed off medications that are not approved for use by said participant. I hereby request and give my permission to the Augustana Lutheran Church health care worker to administer medication to the participant identified above. I understand that all medications must be provided in the original pharmacy labeled container. I understand my child assumes responsibility for going to the health clinic at specified times for medications. I hereby give my permission to Augustana Lutheran Church to give care to the participant identified above in case of illness or injury and understand Augustana Lutheran Church will attempt to contact me in such event. Augustana Lutheran Church and its staff have authorization to obtain medical treatment and procedures for the participant as may be appropriate in emergency circumstances, including treatment by physicians, hospital and clinic personnel, and other appropriate healthcare providers.
Signature of Parent or Guardian
Date
MM slash DD slash YYYY
Email
This field is for validation purposes and should be left unchanged.

Acetampinophen/Tylenol
Alcohol Wipes
Aloe Vera
Ammonia Inhalants
Anbesol
Antacids/Tums
Antiobiotic Ointment
Aquaphor
BioFreeze
Bug Spray
BZK Wipes
Calamine Lotion
Campho-Phenique
Cough Drops
Cough Syrup
Diphen/Benadryl
Emergen-C
Gold Bond Powder
Hydrocortisone CR
Ibuprofen/Advil
Immodium
Insta-Glucose
Psuedoval/Sudafed
Saline Eye Wash
Sunscreen

Vacation Bible School/Day Camp

Vacation Bible School Registration

Child Information

Parent Information

Health Form and Payment

Participant Health Form

Health History

Medications

Parent/Guardian Release