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DAY CAMPJune 22-25, 2015
at Emmaus Road Church
9AM - 3PM*Grades: PreK-6th*
Cost: FREE
Camper InformationName (First & Last)
Address
City State Zip
Phone Email
Male Female Date of Birth / / Grade Entering
Home Church (Optional)
Allergies/Medical Conditions
Emergency Contact: Phone:
Please complete both sides of registration form. Pre-registration is required.
Day camp registration
51BRANDED
DAY CAMPJune 22-25, 2015
at Emmaus Road Church
9AM - 3PM*Grades: PreK-6th*
Cost: FREE
Camper InformationName (First & Last)
Address
City State Zip
Phone Email
Male Female Date of Birth / / Grade Entering
Home Church (Optional)
Allergies/Medical Conditions
Emergency Contact: Phone:
Please complete both sides of registration form. Pre-registration is required.
Day camp registration
51BRANDED
Parents/Guardians InformationName(s)
Home Phone Cell/Work Phone
Parental/Guardian ConsentI hearby give permission for my child to attend an Inspiraiton 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 the host church 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 permis-sion to ride in Day Camp provided transportation. I further authorize Inspiraiton Point and the host church to use photos or video taken of my child at Day Camp for promotional purposes.
Parent/Guardian Signature Date
1811 Elmwood Rd | DeWitt, IA
For more information please contact 563-659-9444email [email protected]
or visit us at www.emmausroadonline.org
Cost: FREE*Pre-K - K program 9:00 - 11:30•Church will provide lunch for campers•Please register by June 12, 2015 by completing the attached registration •form and returning it to: Emmaus Road Church
Day Camp Emmaus Road Church
Parents/Guardians InformationName(s)
Home Phone Cell/Work Phone
Parental/Guardian ConsentI hearby give permission for my child to attend an Inspiraiton 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 the host church 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 permis-sion to ride in Day Camp provided transportation. I further authorize Inspiraiton Point and the host church to use photos or video taken of my child at Day Camp for promotional purposes.
Parent/Guardian Signature Date
1811 Elmwood Rd | DeWitt, IA
For more information please contact 563-659-9444email [email protected]
or visit us at www.emmausroadonline.org
Cost: FREE*Pre-K - K program 9:00 - 11:30•Church will provide lunch for campers•Please register by June 12, 2015 by completing the attached registration •form and returning it to: Emmaus Road Church
Day Camp Emmaus Road Church
