Vacation Bible Camp 2024 - COUNSELOR

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

COUNSELOR 1 Information

Please fill out the following information for the first COUNSELOR (6th-12th grade).

For CAMPERS (Age 3 - 5th grade), please fill out the Camper Form.

Counselor's First Name

Counselor's Last Name

Counselor's Preferred Name (for name tags)

Counselor's Grade in Sept. 2024

Counselor's Birthday

Counselor's Gender

Male Female Other

Counselor's T-Shirt Size

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

Are there any days/times that this Student Counselor won't be available? (We know that schedules change, but if you know of any times now, please let us know!)

COUNSELOR 2 Information

For a second COUNSELOR (6th-12th grade) from the same household.

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

For Campers (6th-12th graders), please fill out the Camper form.

Counselor 2's First Name

Counselor 2's Last Name

Counselor's Preferred Name (for name tags)

Counselor's Grade in Sept. 2024

Counselor's Birthday

Counselor's Gender Male Female Other

Counselor's T-shirt Size

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

Are there any days/times that this Student Counselor won't be available? (We know that schedules change, but if you know of any times now, please let us know!)

COUNSELOR 3 Information

For a third COUNSELOR (6th-12th grade) from the same household.

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

For Campers (6th-12th graders), please fill out the Camper form.

Counselor 3's First Name

Counselor 3's Last Name

Counselor's Preferred Name (for name tags)

Counselor's Grade in Sept. 2024

Counselor's Birthday

Counselor's Gender Male Female Other

Counselor's T-Shirt Size

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

Are there any days/times that this Student Counselor won't be available? (We know that schedules change, but if you know of any times now, please let us know!)

COUNSELOR 4 Information

For a fourth COUNSELOR (6th-12th grade) from the same household.

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

For Campers (6th-12th graders), please fill out the Camper form.

Counselor 4's First Name

Counselor 4's Last Name

Counselor's Preferred Name (for name tags)

Counselor's Grade in Sept. 2024

Counselor's Birthday

Counselor's Gender Male Female Other

Counselor's T-Shirt Size

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

Are there any days/times that this Student Counselor won't be available? (We know that schedules change, but if you know of any times now, please let us know!)

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

Description

August 26-30 from 9am - 2pm

Register for this year's Vacation Bible Camp. If you have more than four counselors at the same address, please contact office@fccofwestfield.org.

To register a Camper (age 3 - 5th grade), please fill out the Camper form: https://fccofwestfield.breezechms.com/form/6cf79f

Vacation Bible Camp 2024 - COUNSELOR

Description

Please Fix the Following