Vacation Bible Camp 2024

PARENT/GUARDIAN Information

Parent/Guardian Name

Parent/Guardian Email

This address will receive a confirmation email

Parent/Guardian Cell Phone

Parent/Guardian Address

How did you hear about Vacation Bible Camp?

Past participant At Church From a Friend Signs on Church Property Social Media Online News Source (TapInto, Patch, etc) Compass Schoolhouse Flyer/Email

CAMPER 1 Information

Please fill out the following information for the first CAMPER (age 3 through 5th grade).

For COUNSELORS (6th-12th grade), please fill out the Counselor Form.

Camper's First Name

Camper's Last Name

Camper's Preferred Name (for name tags)

Camper's Grade in Sept. 2024

Camper's Birthday

Camper's Gender

Male Female Other

Camper's T-Shirt Size

Is there a special friend your child would like to be grouped with? (We do our best to accommodate requests.)

Allergies and/or Special Needs (including behavioral/IEP/504 accommodations)

CAMPER 2 Information

For a second camper from the same household (age 3 through 5th grade).

If you don't have any additional campers, please skip to the Parent/Guardian Information section.

For Counselors (6th-12th graders), please fill out the Counselor form.

Camper 2's First Name

Camper 2's Last Name

Camper's Preferred Name (for name tags)

Camper's Grade in Sept. 2024

Camper's Birthday

Camper's Gender Male Female Other

Camper's T-shirt Size

Is there a special friend your child would like to be grouped with? (We do our best to accommodate requests.)

Allergies and/or Special Needs (including behavioral/IEP/504 accommodations)

CAMPER 3 Information

For a third camper from the same household (age 3 through 5th grade).

If you don't have any additional campers, please skip to the Parent/Guardian Information section.

For Counselors (6th-12th graders), please fill out the Counselor form.

Camper 3's First Name

Camper 3's Last Name

Camper's Preferred Name (for name tags)

Camper's Grade in Sept. 2024

Camper's Birthday

Camper's Gender Male Female Other

Camper's T-Shirt Size

Is there a special friend your child would like to be grouped with? (We do our best to accommodate requests.)

Allergies and/or Special Needs (including behavioral/IEP/504 accommodations)

CAMPER 4 Information

For a fourth camper from the same household (age 3 through 5th grade).

If you don't have any additional campers, please skip to the Parent/Guardian Information section.

For Counselors (6th-12th graders), please fill out the Counselor form.

Camper 4's First Name

Camper 4's Last Name

Camper's Preferred Name (for name tags)

Camper's Grade in Sept. 2024

Camper's Birthday

Camper's Gender Male Female Other

Camper's T-Shirt Size

Is there a special friend your child would like to be grouped with? (We do our best to accommodate requests.)

Allergies and/or Special Needs (including behavioral/IEP/504 accommodations)

Parent/Guardian 2 Information

Emergency contact information for a second parent/guardian. If there isn't an additional parent/guardian, please skip to Additional Emergency Contact Information.

Name

Cell Phone

Additional Emergency Contact Information

Please provide the name of someone other than parents/guardians. In all cases, we will attempt to reach parents/guardians first. Only if you can't be reached will we contact your emergency contact.

Name

Cell Phone

Medical Release

In the event that my child(ren)'s parents/guardians or emergency contacts cannot be reached, I authorize all necessary medical treatment as prescribed by attending physician and/or emergency response personnel, and I release First Congregational Church from liability.

Please choose:

Yes No

Photo/Video Release

I give First Congregational Church permission to use photos/videos of my child(ren). Use may include, but is not limited to, website, social media, and emails.

Please choose:

Yes No

Payment

Please choose the number of Campers you are registering.

The registration fee is $80 for the 1st and 2nd child from the same household. The registration fee is $65 for 3rd and 4th child from the same household. Please note: credit card fees are included in the registration fees.

Payment

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Vacation Bible Camp 2024 - CAMPER

Description

Vacation Bible Camp 2024 - CAMPER

Description

Please Fix the Following