Camp Chaos (VBS 2025) - Participant Form

Please fill out one form for EACH child who will be participating in Camp Chaos.

Camp Chaos runs from June 23-26 from 9am-12pm.

For questions, please reach out to Missy Smith (msmith@stmattlutheran.org), 717-637-7101, ext 232
or Pastor Alex (pastoralex@stmattlutheran.org), 717-637-7101, ext 229.

Child's Information

Child's Name

Date of Birth

Rising Grade (2025-2026 School Year)

Please select one option.

Pre-K Kindergarten Grade 1 Grade 2 Grade 3 Grade 4 Grade 5

T-shirt size

Please select one option.

Youth Small Youth Medium Youth Large Youth Extra-Large Adult Small Adult Medium

Child Plans to Attend (check all that apply)

Please select all that apply.

Monday - June 23 Tuesday - June 24 Wednesday - June 25 Thursday - June 26

Address

Please list allergies and dietary concerns.

We want every child to feel safe, included, and supported. Please let us know if there is anything we should be aware of to help make this a positive experience for your child (medical needs, learning or behavioral supports, etc.).

We love sharing the fun and joy of our programs! We may take photos during events to share on our church’s website, social media, or printed materials.

Please select all that apply.

Check this box if you do NOT give permission for your child's photo to be used.

Primary Adult Contact Information

Primary Adult Contact Name

Relationship to Child

This address will receive a confirmation email

Cell Phone

Emergency Contacts

Emergency Contact Name

Phone

Relationship to Child

Emergency Contact Name

Phone

Emergency Contact Name

Pick-Up Information

To help us keep your child safe, please list any other adults who have permission to pick up this child. Please include their relationship to the child. (e.g. John Smith - Neighbor)

Camp Chaos (VBS 2025) - Participant Form

Description

Please Fix the Following