LWF Day Camp 2019 Registration
Please fill out this form once for each child you are registering. The $10 registration fee per child will be due at the start of Day Camp. If you have any questions, please contact Dena Venneman, Loni Ziman, or the Church Office.
Child's First Name *
Your answer
Child's Last Name *
Your answer
Home Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Best Family Phone Number *
Your answer
Gender *
Date of Birth *
MM
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DD
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YYYY
Grade Entering *
Your answer
What church do you attend? (Optional)
Your answer
Allergies/Medical Conditions
Your answer
Parent/Guardian Name(s) *
Your answer
Parent/Guardian Cell Phone *
Your answer
Parent/Guardian Secondary Phone (Optional)
Your answer
Parent/Guardian Email
Your answer
Emergency Contact Name *
Your answer
Emergency Contact Phone *
Your answer
I hereby give permission for my child to attend an Inspiration Point Day Camp and designate Day Camp officials to act on my behalf in authorizing routine and/or emergency medical care. I also agree to hold harmless Lutheran Brethren Bible Camp, Inc. and Living Word Lutheran Brethren Fellowship for any and all claims for injuries, causes for action, or liability related to the Day Camp facilities or activities. I give Day Camp officials authority in matters of discipline, understanding that any camper disregarding Day Camp rules is subject to being sent home. I give my child permission to ride in Day Camp provided transportation. I further authorize Inspiration Point and Living Word Lutheran Brethren Fellowship to use photos or videos taken of my child at Day Camp for promotional purposes. *
Please type your name to verify that you agree to the above terms and conditions of attendance. *
Your answer
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