Dei Camp Registration July 22-25, 2024

Child(ren) Information

Complete this section for each child in your household who will attend Dei Camp. After you've clicked on the green Submit button, you will see instructions for how to enter additional children on the screen.

After you're done entering your child(ren)'s information, move on to the Household Information portion of this form.

Your final step will be to click on the red Submit or Submit & Pay button.

Household Information

Please provide information about the adult(s) in the household here.

Name

This address will receive a confirmation email

Please enter cell phone number with area code:
xxx-xxx-xxxx

Phone

Parent/Guardian #2 Name

Parent/Guardian #2 Email

Please enter cell phone number with area code:
xxx-xxx-xxxx

Parent/Guardian #2 Phone

How can I help?

We need adult help to make the week work. Are you able to help? Even one day is appreciated!

I'd like to help lead a group each day. I can't come every day, but I'd like to help out when I can. I'd like to provide lunch for volunteers and counselors. Please contact with more information about how I can help.

Emergency Contact Information

The parent(s)/guardian(s) listed above will be contacted at the cell phone number(s) provided in the case of emergecy. Please provide 2 alternate emergency contacts.

Emergency Contact name and phone

Emergency Contact name and phone #2

Permissions

I give permission for my child to attend and participate in the above event sponsored by Gloria Dei Lutheran Church.

Yes No

In the event that I am not immediately available for consultation in an emergency, I authorize an adult, in whose care my child has been entrusted, to consent to any X-ray examination, anesthetic, medical, surgical or dental diagnosis or treatment, and hospital care, to be rendered to my child under the general or special supervision and on the advice of any licensed physician or dentist on the medical staff of a licensed hospital, whether such diagnosis or treatment is rendered at the office of said physician or at said hospital. I shall be liable and agree to pay all costs and expenses incurred in connection with such medical and dental services rendered to my child pursuant to this authorization.

Yes No

Events may be photographed or videoed for publicity purposes and may be posted on the Gloria Dei website and/or social media platforms. Please contact Gloria Dei to opt out.

I consent to receive communications (which may include a phone, mail, email) from Gloria Dei. I understand I may proactively manage my preferences or opt-out of communications with Gloria Dei at any time by contacting the Church Office.

I agree

Checking this box acknowledges my electronic signature (required).

I agree.

Payment

All payments are non-refundable.

Use the dropdown box below to select the number of children you are registering. If you are paying at the door by check or with correct change, you will find that option here as well.

Payment

FOR OFFICE USE ONLY: Record of Payment for 'Pay at Door' || Date Received / Payment Type / Amount / Received by Initials

FOR OFFICE USE ONLY: Paper Form

Gloria Dei Lutheran Church respects your privacy.

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Dei Camp Registration July 22-25, 2024 | 9:00am - 3:00pm

Description

Dei Camp Registration July 22-25, 2024 | 9:00am - 3:00pm

Description

Please Fix the Following