Middle School Fun Nights 2024

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Middle Schooler's Name

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Entering Grade

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Please select one option.

6th 7th 8th

Relationship to Good Shepherd

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Involved/Member Friend of Member

Adult Phone

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Adult Email

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This address will receive a confirmation email

We'd like more information about Good Shepherd and Middle School Ministry

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Please select all that apply.

Yes No

Medical/Dietary Notes

Behavioral/Social/Emotional Notes

Which summer fun nights would you like to register for?

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Please select all that apply.

Wed June 19 6:00-7:30pm Wed, July 10 6:00-7:30pm Wed, July 24 6:00-7:30pm Wed, Aug 14 6:00-7:30pm

Payment

1 Fun Night ($10) 2 Fun Nights ($20) 3 Fun Nights ($30) 4 Fun Nights ($40) Assistance ($0)

Amount

I consent that my child has permission to participate in camp activities, under supervision. Good Shepherd Lutheran church and its personnel will not be held responsible for accidents or personal injury arising there from. (Type as Signature)

*

Credit/Debit Card Number

Expiration Date/CVC

Name on Card

Card Billing Address

Description

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