Vacation Bible Camp Registration

Vacation Bible Camp Registration

June 15-18, 6:00pm-8:00pm

Family Dinner @ 5:30pm

Please complete one form per family. If there are more than 3 campers in one family, please complete additional forms. Thank you!

Camper First Name

Camper Last Name

Camper Age

Camper First Name

Camper Last Name

Camper Age

Camper First Name

Camper Last Name

Camper Age

Parent/Guardian 1 First Name

Parent/Guardian 1 Last Name

Parent/Guardian 2 First Name

Parent/Guardian 2 Last Name

Preferred Email Address

Phone

Street Address

City

State

Zip Code

In case of emergency, contact:

Emergency Contact Phone

Please list any allergies or other special needs

I give permisson for the person(s) named on this form to participate in Vacation Bibe Camp (VBC) at First Presbyterian Chuch Valparaiso (FPCV). I understand that this may include a variety of activities on church property, and participation carries an ordinary level of risk of possible injury. I understand that participation in VBC is, by its very nature, a Christian-based activity. I understand that participation in FPCV activities is dependent upon appropriate behavior and FPCV staff/volunteers maintain the right and responsibility to allow participation. FPCV is a welcoming Christian community that strives to create a safe, encouraging environment for all God's people. FPCV staff/volunteers adhere to FPCV safety practices and policies.

I give permission for FPCV staff/volunteers to administer basic first aid to the person(s) named on this form in the event of an injury. I understand that FPCV staff/volunteers will contact emergency services in the event of a significant injury and all expenses for such emergency services will be paid by Parent/Guardian.

I give permission for FPCV to use images/video(s) of the person(s) named on this form for the purposes of FPCV communications, promotions, etc. Such images/videos may be used in FPCV print publications, electronic communications, social media, etc.

I DO NOT give permission for FPCV to use images/video(s) of the person(s) named on this form for the purposes of FPCV communications, promotions, etc. Such images/videos may be used in FPCV print publications, electronic communications, social media, etc.