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Day Camp 2009 was wonderful with lots of fun, singing, and hands on Bible activities. Here are some pictures from this year at: http://saintjacob.shutterfly.com/

A Day Camp registration form is at the bottom of this page!!!

Do you remember any of these counselors from our Day Camp.......

ABBY...from Ashland and goes to Bluffton College. She LOVES the Cleveland Indians and I Corinthians 10:31.

ANDREW...grew up in Lima and attends Valparaiso University. He does ballroom dancing and his favorite verse is I Peter 4:11.

BRENNA...spent her childhood in Medina and also goes to Valparaiso University. She likes I Corintians 13.

BROOKE...from Delphos and goes to the amazing Capital University. Did you know she had reconstructive surgery on her nose? Her Bible fav is Hebrews 13:1-3.

DRAKE...his hometown is Cortland and he attends THE Ohio State University. He just had his wisdom teeth taken out and loves Psalm 23.

GREG...calls Westlake his home and Kent State his college. He does a mean Cosby impression and especially likes Matthew 8:26. 

IAN...grew up in New Philadelphia and goes to Waynesburg University. He is a member of the reigning intramural volleyball team at his college! His favorite verse is Galations 2:20.

KARA...she is from Wauseon and is a student at Ashland University. She loves the rubics cube (she can solve them) and she also loves I Corinthians 15:57-58.

SARAH...likes the letter W as she is from Wadsworth and attends Wittenberg University. She loves running and Mark 5. 

VICTOR...he came to us all the way from the Ukraine! Odessa is his hometown. He does martial arts and works at Gloria Bible Camp in Ukraine. His favorite verse is Mark 10:45.

Day Camp 2009 is July 6-10. Please call 866-4324 for more information.  Registration blanks are in the church office (10-noon on MWF) or print what is below. The camp is from 9-3 every day and the theme this year is “Love to Serve” with Mark 10:45 as the Bible verse for the week....”For the Son of Man came not to be served but to serve, and to give his life a ransom for many.”
    SUMMER DAY CAMP REGISTRATION
       camp date: July 6-10, 2009
Name of Camper____________________________
Birth date_____________ Gender______________
Address, City, State, Zip______________________
  _______________________________________
Grade completed___ age:__Home Church________
Parent/Guardian Name(s)_____________________
Home Phones_______________________________
Work Phones_______________________________
Cell Phones________________________________
Email_____________________________________
Emergency Contact Information
1. name__________________________________
 address__________________________________
2. name__________________________________
 address__________________________________

During Day Camp, how will your child come and leave from the day camp site? (circle all that apply)
     walk        bike         car
The following person(s) is/are permitted to pick up my child from Day Camp: 1.______________________
2.___________________3.___________________
4._______________________________________

DO NOT release my child to the following person(s):
1.___________________2.___________________

           Parent Permission
To the best of my knowledge, this health history is correct and complete. I hereby give permission for use of photos of my child to be used in promotion. I hereby give permission for the above named child to participate in all LOMO Day Camp activities at St. Jacob Lutheran in Miamisburg. I hereby give permission for my child to be transported to an off-site activity by an adult driver including field trips and special events on or away from the church’s property as listed: Germantown Reserve Cottonwood Shelter, 6910 Boomershine Rd. Germantown, OH 855-7717 on Wednesday, July 8th
______________________parent/guardian signature
date_________please print name________________ 

         Required Health Information

Doctor’s Name______________ Dr. Phone________
Dentist’s Name_____________ Dent. Ph._________
Your Medical Insurance Carrier__________________
Group Number_______________________________
Name of Policy Holder_________________________
Policy Holder’s Number________________________
List any disability or recurring illness:____________
Note any activities to be limited_________________
Specify any dietary concerns or limitation_________
__________________________________________
Indicate current medication or medical treatment:
Note: All medications sent to camp must be in the original containers and given to the Adult Coordinator
            Name            Dosage
1.________________________________________
2.________________________________________
3.________________________________________
Note all allergies:
Bee Stings_Aspirin_Penicillin_Peanuts_Other______

Immunization Record - Please note the dates of the following immunizations or check current_____
DTP:    Tetanus/Diptheria:    Tetanus: 
Varicella (chicken pox):    MMR:    Polio:
MMR:     Haemophius Influenza B:
Hepatitis B:

Please clarify anything else that might help the Day Camp staff regarding your child, especially related to behavioral, physical, emotional, or mental health:
_________________________________________

      AUTHORIZATION OF TREATMENT
In the event I cannot be reached, I give permission for the staff of this Day Camp to order X-rays, routine tests and medical treatment for my child until I can be present or involved in the care. I give permission for camp staff to administer medication as listed further on this form

________________________ _____ _______________________
 parent/guardian signature   date    please print name
St. Jacob Lutheran Church on 213 E. Central Ave.
Miamisburg, Ohio 45342 866-4324 www.stjacob.net