VBSRegistration

FAITH COMMUNITY CHRISTIAN CHURCH

2017 Vacation Bible School Registration
& Photo Release Permission
August 14th - August 18th
6:00pm - 2017 8:30pm
Door opens at 5:30pm
Graduation: Friday, August 18th
Faith Community Christian Church
35459 Dumbarton Ct. Newark, CA 94560

* Indicates required field

Child's Name *

First

Last

Child's Gender *

Male Female

Date of Birth MM/DD/YY *

Name of Parent/Guardian *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Home Phone Number *

Parent/Caregiver's Cell Phone Number *

Email *

Home Church Name *

Pick-up Authorization

The only person(s) authorized to pick-up your child/children are the individuals listed below. Upon check out, they will be asked to verify their identity with a picture ID. Please be advised that we will not release your child to anyone who is not named on this form without proper notification.

Please make sure to list ALL possible individuals (including yourself) authorized to pick up your child/children from FCCC's summer program.

ENTER NAMES AS IT APPEARS ON PHOTO IDENTIFICATION CARD:

1. Name *

First

Last

Relationship *

2. Name *

First

Last

Relationship *

3. Name *

First

Last

Relationship *

MEDICAL INFORMATION

Allergies or other medical conditions *

In case of emergency, contact *

First

Last

Cell Phone Number *

PHOTO PERMISSION

From time-to-time we take pictures/video during church activities. We would like your permission to use these pictures/videos on our website, in videos and/or on our bulletin boards.

Pictures/videos would be selected to highlight activities during Sunday School, our class environment, or church events.

We will never reference your child by name or provide any specific information regarding your child.

These pictures/videos will only be used by Faith Community Christian Church to show the many ways our children & youth can have fun while participating in church.

Please take a moment to let us know your preferences regarding our use of photos/videos of your child:

I grant permission for you to use photos/videos of my child on Faith Community Christian Church’s website, in videos, bulletin boards, and/ or newsletters or Facebook. *

YES, I grant permission for you to use photos/videos of my child NO, Please do NOT use any photos/videos of my child

WAIVER AND RELEASE FORM

I recognize and acknowledge that there are certain risks of physical injury to participating in the indicated programs/activities and I agree to assume the full risk of any such injuries, damages or loss regardless of severity which I, any member, or my child may sustain as a result of participating in any activities connected or associated with any such programs. I further agree to waive and relinquish any and all claims I or my child may have against Faith Community Christian Church, its officers, leaders, and servants from any and all claims from injuries, damages or loss which I, any member, or my child have which may accrue on account of my participation or the participation of my child in any of the above programs. I have read and fully understand all information.

Name *

First

Last

Today's Date MM/DD/YY *

For questions/concerns about this form,
please email Children’s Ministry at CE@FCCCEastBay.org

Review your form BEFORE you click the SUBMIT button.

Please click SUBMIT to forward this to the church office.

Submit