Gloria Dei Lutheran Church and School
2016-2017 Bible Camp Registration

Which Bible Camp(s) are you registering the following child(ren) for?
Please check all that apply. For our Summer Music Camp, please visit our Summer Music Camp page.
Child #1's Name *
Child #1's Name
Only applies for Summer Bible Camp. Shirts will only be able to be provided for children registering before May 1, 2017.
Child #2's Name
Child #2's Name
Only applies for Summer Bible Camp. Shirts will only be able to be provided for children registering before May 1, 2017.
Child #3's Name
Child #3's Name
Only applies for Summer Bible Camp. Shirts will only be able to be provided for children registering before May 1, 2017.
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.