Gloria Dei Lutheran Church and School
Summer Bible Camp Registration
June 17-21, 2019, 9-11:30am

Please Note: Some schools (especially the San Mateo / Foster City district) have school through June 20. An option has been added to register your children for the whole week or just Friday the 21st if they’ll be in school Monday-Thursday of our camp week. If you have any questions, please contact Pastor Shrimpton!

Child #1's Name *
Child #1's Name
Is your child registering for the whole week or just Friday?
Child #2's Name
Child #2's Name
Is your child registering for the whole week or just Friday?
Child #3's Name
Child #3's Name
Is your child registering for the whole week or just Friday?
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.