Bible Soccer Camp & VBS

June 26-28

Bible Soccer camp

Kindergarten - 6th Grade

Time: 9:00 AM - Noon

Location: Nelson Elementary School Field, NE corner of 224th and 108th

Vbs

Preschool - 6th Grade

Time: 9:15 AM - 11:45 AM

Location: St. Paul Lutheran Church, SE corner of 224th and 108th

Registration

Program *
Please select the program you are registering your child for
Child *
Child
The name of your child attending Bible Soccer Camp or VBS
Address
Address
Home address where your child lives
Home Phone Number *
Home Phone Number
The best contact for reaching your child's primary residence
The grade your child just finished.
Parent/Guardian Information
Please fill out at least one of the following three: Mother's name and phone, Father's name and phone, or legal guardian's name and phone.
Parent/Guardian 1
Parent/Guardian 1
Phone
Phone
Parent/Guardian 2
Parent/Guardian 2
Phone
Phone
Parent/Guardian 3
Parent/Guardian 3
Phone
Phone
Please list any food allergies, food related medical conditions or medical conditions pertinent to sports and physical activity
Emergency Contact *
Emergency Contact
Phone *
Phone
Consent *
I understand that I have a duty to provide primary accident and medical insurance for my child/ and I declare that my child is covered by primary accident and medical insurance. I Release and forever discharge The Lutheran Church of St. Paul and their agents and servants, successors and assigns, directors, trustees, officers, employees and other representatives from any and all damages of my child's participation in, attendance at, and travel to and from activities and events. Furthermore, I do hereby expressly stipulate, and agree to indemnify and hold forever harmless The Lutheran Church of St. Paul and its agents and servants, successors and assigns, directors, trustees, officers, employees, and other representatives against loss from any and all present or future claims, demands, or actions in law or in equity that may hereafter be made or brought my me or my child, by anyone on behalf of me or my child, or by anyone else on their own behalf for damages or any other legal or equitable remedy on account of any injury, illness, physical condition, inconvenience, or loss sustained by me or my child during the event or travel to and from the same. By checking "I Agree" below, I hereby acknowledge that I have read the foregoing, understand its contents, and have consented the same as my own free act and deed.
The children at Bible Soccer Camp and Preschool VBS will be photographed and filmed during the week. We may use the photographs/films to be used on our website. If you do not want your child's photograph/video to be used on our website, please check the box below.
Authorization *
By checking yes, you are acknowledging that this form was filled out by a legal parent or guardian of the child. Whose name is entered below.
Name *
Name
Name of legal guardian who filled out this form, provides consent and authorization.