Middle School Fun Nights 2026

Child Information

Please complete one form for each child.

Child's Name

Address

Phone

*This number will be used in case of emergency.

This address will receive a confirmation email

*This email will be used for Middle School Fun Nights communication.

Birthdate

Entering Grade

Consent to Photography Use

*for congregational purposes

Medical Concerns/Allergies Yes

Explanation Information

Behavioral/Learning Concerns Yes

Additional Information

Parent Information

First Parent Name

First Parent Email (if different than above)

First Parent Phone (if different than above)

Second Parent Name

Second Parent Email

Second Parent Phone

Please indicate your church relationship

I would like more information about Good Shepherd Yes

Emergency Contact Information

Name

Mobile

Name

Mobile

Camp Information

Middle School Fun Night 2026 Offerings

Middle School Fun Nights: (1) June 17 (2) July 8 (3) July 22 6:00-7:30pm, Entering grades 6-8, $10 per child/per night, Verona Campus

All Youth Bash: August 11, 6:00-7:30pm, completed K-12th grade, $20

Middle School Fun Nights

MS Fun Nights (1): June 17 MS Fun Nights (2): July 8 MS Fun Nights (3): July 22 All Youth Bash: August 11

Payment Information

Please select the appropriate payment option for the camp you are attending. Note: You have to add the payment option for EACH fun night your child is attending.

MS Fun Nights (1) June 17 payment option

MS Fun Nights (2) July 8 payment option

MS Fun Nights (3) July 22 payment option

All Youth Bash August 11 payment option

Help offset cost of web processing fees for card payments

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.

Yes

Signature (Type Name)

*By typing your name here, you are signing this application electronically. You agree your electronic signature is the legal equivalent of your manual signature on this registration form.

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Middle School Fun Nights 2026

Description

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