Gloria Dei Lutheran Church and School
Winter Bible Camp Registration
December 9, 2017, 1-3:30pm

Child #1's Name *
Child #1's Name
Child #2's Name
Child #2's Name
Child #3's Name
Child #3's Name
If none write "none."
Medical Release *
I give my permission for the staff to administer basic first aid to my child(ren) (named above) in the event of an injury. I understand that the staff will contact emergency services in the event of a significant injury and all expenses for such emergency services will be paid by me.
Photo Release *
I give permission to Gloria Dei to to copyright and use photographs/videos taken at the Bible Camp(s) of the minor(s) designated above in any manner or form for any purpose lawful at any time. I waive any right that I may have to inspect or approve the finished product or written copy, that may be used in conjunction therewith, or the use to which it may be applied.
Parent/Guardian Name *
Parent/Guardian Name
Parent/Guardian Address *
Parent/Guardian Address
Parent/Guardian Phone Number *
Parent/Guardian Phone Number
Emergency Contact Name *
Emergency Contact Name
Emergency Contact Phone Number *
Emergency Contact Phone Number
Alternate Pickup Name
Alternate Pickup Name
Alternate Pickup Phone Number
Alternate Pickup Phone Number
Permission *
I give permission for my child to attend the Bible Camp(s). I understand that this registration information will only be used by Gloria Dei and will not be shared with or sold to any other institution or company.