FBC Diana Sports Camp 2018
Thank you for your interest in Sports Fun Camp presented by FBC Diana, August 12-15, 2018. Time 6PM - 8:30PM Nightly
For information about the church please visit our website www.FBCDiana.org.

*Please note that you will need complete the form for each child that will attend.

Email address *
Parent/Guardian Name *
Your answer
Home Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Parent/Guardian Mobile Number *
Your answer
Parent/Guardian Home Number
Your answer
Parent/Guardian Relationship to Child *
Your answer
Parent/Guardian Email Address *
Your answer
Emergency Contact Name *
Please provide an emergency contact person other than yourself.
Your answer
Emergency Contact Phone Number *
Please provide the best phone number to reach the emergency contact.
Your answer
Child's Name *
Your answer
Child's Date of Birth *
MM
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DD
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YYYY
Child's Sex *
2018-2019 School Grade *
Select the grade your child will enter for the 2018-2019 year.
Name of Child's School *
Your answer
Any Medical Concerns
Please note any concerns you may have for this child's participation in sporting and physical activities.
Your answer
Any Severe Food Allergies
Please note any severe food allergies this child may have.
Your answer
Today's Date *
MM
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DD
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YYYY
Medical & Activity Release *
My child has my permission to engage in prescribed activities, except as noted by me. In the event I cannot be reached in an emergency, I hereby give permission to the physician selected by an adult leader in charge, to medical treatment that may be deemed necessary by a physician to ensure the well being of the above named participant, due to sickness or accident while attending activities of FBC Diana. I also authorize adult sponsors to transport my child at their discretion in the case of an emergency. I represent to you that I and the participant hold FBC Diana, its agents, employees and representative harmless from all liability arising from the conduct of the participant and agree to defend and indemnify FBC Diana, its agents, employees and representatives against any claim or liability arising as a result of such conduct. Media Consent: I give my consent and permission for the taking of photographs and/or video of me (or my child) during the described event and waive and/or assign any and all rights (including copyright) in such media to FBC Diana, as the sole owner of such media, shall have the exclusive right to control and determine the use, display, performance, reproduction and dissemination of any such photographs and/or videos. Photos may be used daily to recap the day in a video for the kids to watch.
A copy of your responses will be emailed to the address you provided.
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