SUMMER CAMP

Parent/Guardian Name *

Parent/Guardian Address: *

Parent/Guardian Phone Number *

To be used in case of emergency.

Child's Name / D.O.B. / Grade *

Child Tshirt Size *

Is your Child allergic to anything? *

We will be traveling on a bus, do you give GlorylandWaco permission to transport your youth to different activities? *

My youth will be attending: *

Cost is the same as it covers the tshirt and 1 meal. The rest is covered by the church.

Does your child attend church anywhere other than GlorylandWaco? (If so, please list the church)

Picture release:

HEALTH INSURANCE: I further certify that I have a personal health insurance policy in force with this company which covers my child, that will provide coverage for my child during the duration of GloryCamp event, including accidental death and dismemberment (AD &D) coverage. Provide Health care Insurance Company / Policy # / Phone number. *

By selecting this box I do hereby release and hold harmless GloryCamp, Glorylandwaco, its officers, trustees, agents and employees from finanical responsibility and/or personal liability resulting from what may be deemed as negligent acts or omissions in connection with my child voluntarily participating in this event.

I have read and do not hold Glorylandwaco responsible.

In case of Emergency, please call (Name / relationship to child / phone number:

Please list the names any other siblings that are also attending Glorycamp:

Any additional comments or concerns:

GLORYCAMP / JUNE 28-30

↑

Follow us: 