CCCGW VBS Registration Form
Host Church: Chinese Christian Church of Greater Washington DC
Partner: Joy EI Camps and Retreats (
Date and Time: July 9 - 13, 9am - 3:30pm
Age: 3 year - 5th Grade
Theme: Around the World in 80 Days
Cost of Week of Camp: $25/kid, maximum $50/family

1. Fill out this form and submit it online
2. Make a check payable to "CCCGW", for "VBS", and mail it to 7716 Piney Branch Road, Silver Spring, MD 20910
3. Download the health form, fill out and submit it on the first day of VBS

Camper Name (First & Last)
Your answer
Birthday (mm/dd/yyyy)
Your answer
School Grade Completed
Your answer
Father/Guardian Name
Your answer
Mother/Guardian Name
Your answer
Your answer
Your answer
E-mail Address
Your answer
Please List all Food Allergies
Your answer
Parent Consent Statement
In signing this statement, I certify that this camper is in good health and may participate in ordinary camping activities. Joy El will in no way be responsible for medical treatment or liability resulting from physical conditions existing prior to the camper coming to this event. I hereby authorize release of medical information necessary for insurance purposes to Joy El. In the event of an emergency and I CANNOT be located, I give permission for the hospital doctor to treat my child or operate.

I give Joy El permission to use pictures that include the camper listed able in print or internet for publicity purposes.

I give permission for Joy El to send me news and information to the email I have supplied above.

As a parent/guardian of camper(s), I hereby fully waive, release and discharge Joy El Camps & Retreats, its agents, employees, successors and assigns, from any and all rights, claims, and actions, arising now and/or in the future, out of my child’s participation in camping activities conducted by and/or under the auspices of Joy El Camps & Retreats. I further agree to indemnify and hold harmless Joy El Camps & Retreats from any claims arising out of any injury or harm my child may cause to another individual during the course of his participation in camping activities. This includes all activities described on brochures and the web page, including but not limited to the Giant Swing, Flying Squirrel, or Zip line.

Date of Signature
Your answer
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