Faith Community Church 2019 VBS
July 7 - July 12, 2019 For Children 4 years old thru 6th Grade
Doors Open: 5:30 pm
Check-in Closes: 6:10pm
Pick-up: 8:30pm
2240 S. Dupont Hwy, Camden DE 19934
VBS@fccde.org
(This is a web based form using a cloud service to store information)
How did you find out about our VBS Program? *
Child Participant Information
Each child attending will require their own form submission.
Child Last Name *
Your answer
Child First name *
Your answer
Child's Nickname (if applicable)
Your answer
Gender *
Child's Birthday *
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Age as of July 7, 2019 *
Grade COMPLETED for 2018-2019 School Year *
Known Food/Other Allergies or Medical Concerns/Special Needs
Your answer
Parent/Guardian Information
Parent/Guardian Last Name *
Your answer
Parent/Guardian First Name *
Your answer
Mailing Address *
Your answer
City *
Your answer
State *
Your answer
Zip code *
Your answer
Parent/Guardian Email Address *
Your answer
Phone Number of Parent/Guardian *
Your answer
Other Form of Contact (If Applicable)
Your answer
Home Church *
Your answer
Emergency Contact Information
Name and phone number of any additional Emergency Contact Person(s) other than Parent/Guardian originally listed
Emergency Contact Person *
Your answer
Emergency Contact Phone Number(s) *
Your answer
Additional Authorized Adult(s) to Pick-Up Child (include phone numbers)
Your answer
Terms and Conditions
*Agreement of ALL terms are required for the listed Child's participation in the 2019 FCC VBS Program. Questions? Please contact VBS@fccde.org
1. I understand that my child may participate in physical activities, such as those held during game times. As with any physical activity, there is a risk of injury. I fully accept this risk and hold harmless from any legal liability, Faith Community Church (FCC) and any persons/volunteers in the FCC VBS Ministry team. *
2. In the event of an emergency that requires medical treatment for the above named child, I understand every effort will be made to contact me and/or my emergency contact. However, if I/we cannot be reached, I give my permission for the FCC VBS team members to secure the services of a licensed physician to provide the care necessary for my child's well being. I assume responsibility for all costs connected to any accident or treatment of my child. *
3. I give Faith Community Church (FCC), Camden DE and its VBS Program permission to photograph and/or video my child and post pictures on the Faith Community Church website, social media pages, and/or printed forms of publicity associated with Faith Community Church. *
I have read and agreed to ALL the Terms and Conditions stated above. (Parents/Guardian's Electronic Signature)
Your answer
Date of Submission *
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Submit
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