VBS Soccer Camp at Christ Lutheran Church

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June 17-21, 2019
9 am - 12 pm

Email *

Parent/Guardian Name (First and Last) *

Phone Number *

Child 1 Name (First and Last) *

Child 1 Age *

Child 1 Allergies and/or Food Restrictions

Child 2 Name (First and Last)

Child 2 Age

Child 2 Allergies and/or Food Restrictions

Child 3 Name (First and Last)

Child 3 Age

Child 3 Allergies and/or Food Restrictions

My home church is... (if none, type none) *

I hereby give my consent as the parent/guardian of the above named child/ren to attend/participate in the VBS Soccer Camp program More than Conquerors at Christ Lutheran Church at 13009 N Elderberry Ct, Lodi, CA 95242. My child/ren and I hereby release, indemnify, and hold harmless the church, its employees and/or volunteers from any and all liability from any claim, injury, or loss sustained by or during my child/ren's participation in the VBS Soccer Camp program More than Conquerors. I hereby authorize Christ Lutheran Church to take and use photography of my child for crafts and keepsakes. Please type your name in the box below agreeing with this consent form. * *

I, as the parent/guardian of the above named child/ren authorize Christ Lutheran Church to take and use photography and/or video of my child for promotional purposes in any type of media and I understand I will not be compensated for any such use. Please type your name in the box below agreeing with this consent form. If you do not consent, do not type your name.

A copy of your responses will be emailed to the address you provided.

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