Child #1's Name *

First Name

Last Name

Child #2's Name

First Name

Last Name

Child #3's Name

First Name

Last Name

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.

Yes

No

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.

Yes

No

Parent/Guardian Name *

First Name

Last Name

Parent/Guardian Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parent/Guardian Phone Number *

(###)

###

####

Emergency Contact Name *

First Name

Last Name

Emergency Contact Phone Number *

(###)

###

####

Alternate Pickup Name

First Name

Last Name

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.

Yes

No