2024 "Start the Party" Bible Camp Registration
First United Presbyterian Church of Dale City
July 22 - 26, 2024
6:00 - 8:00 PM
(Doors Open at 5:45PM)

www.fupcdc.org
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Email *
Full Name *
Please fill out a separate form for each child
Nickname
The name your child likes to be called
Child's Birthdate *
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Grade in the Fall of 2024 *
The grade your child is entering this fall. [Note: all preschool students need to be potty trained.]
Child's Age *
at the time of Bible Camp (July 10-14, 2023)
Child's pronouns *
Required
Buddy Preference:
Someone of similar age/grade who should also request your child
Mailing Address *
(1) Parent/Guardian’s Name *
(1) Parent/Guardian’s E-mail Address *
(1) Parent/Guardian's Primary Phone *
example: (828) 437-1811
(2) Parent/Guardian's Name
(2) Parent/Guardian’s E-mail Address
(2) Parent/Guardian's Primary Phone
example: (828) 437-1811
Home Church
Does your child have any medical condition(s) (medications, etc.) of which we should be aware?       *
If YES, please explain below.
medical condition(s) (medications, etc.)
Does your child have any food allergies or other allergies of which we should be aware?       *
If YES, please explain below.
food allergies or other allergies
Is there anything else we should know to help us care for your child?  
Persons to be contacted in case of emergency (other than parent or guardian): *
Name of Person 1:
Phone Number of Person 1: *
example: (828) 437-1811
Relationship to Child of Person 1:
Persons to be contacted in case of emergency (other than parent or guardian): *
Name of Person 2:
Phone Number of Person 2: *
Relationship to Child of Person 2:
Persons, other than a parent/guardian, (ID required) permitted to pick up my child are:
Persons, other than a parent/guardian, (ID required) permitted to pick up my child are:
Persons, other than a parent/guardian, (ID required) permitted to pick up my child are:
TEXT "@presparty" to 81010 to receive Start the Party!  Bible Camp text alerts!   *
If you can volunteer to help with Bible Camp TEXT "@vbc24" to 81010 to receive Volunteer text alerts!  
Clear selection
I understand that DROP OFF is between 5:45 - 6:00 PM each day. *
Required
I understand that PICK UP is at 8:00 PM each day. *
Required
This year, we invite all the 2024 Bible Camp participants to be a part of Bible Camp Sunday Worship on Sunday, July 28, 2024 at 10:00 AM! Each child will have a part in leading worship at First United Presbyterian Church of Dale City, VA. We ask that all participants arrive at 9:45 AM.
*
The undersigned gives permission for their child to participate in the above named activity and releases First United Presbyterian Church of Dale City, their officers, employees, and agents from any liability whatsoever for any injury or death to person or loss or damage to property sustained by the undersigned for any member of his or her family in attendance, and the undersigned agrees to defend and indemnify First United Presbyterian Church of Dale City, their officers, employees, and agents from any liability or loss they might sustain by reason thereof. In the event I cannot be reached in an EMERGENCY, I hereby give permission to the physician selected by the Pastor, Children's Ministry Director, or VBC Director of First United Presbyterian Church of Dale City to hospitalize, secure proper treatment for, and order injection, anesthesia, or surgery for my child as named above.  By signing this registration form you agree that any photographs and video taken of your child at or during this event are the property of First United Presbyterian Church of Dale City and may be used in future publications as deemed appropriate. *
Electronic Signature
Date *
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A copy of your responses will be emailed to the address you provided.
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