Camp Firelight VBS Form

Camp Firelight VBS Form

First Presbyterian Church Cherryville, NC
General Information
Child Name

First NameLast Name
Parent/Guardian Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Birth Date

MonthDayYear
Gender
Grade
(The grade they were in before summer began)
Photo Release
Are we allowed to post pictures on the church website and Facebook?

Residence Information
Current Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Emergency Contact Information
Primary Emergency | Contact Name

First NameLast Name
Primary Emergency | Phone Number
Please enter a valid phone number.
Primary Emergency | What is your relationship with this person?
Secondary Emergency | Contact Name

First NameLast Name
Secondary Emergency | Phone Number
Please enter a valid phone number.
Secondary Emergency | What is your relationship with this person?

Please list any of the following; current medications, medication allergies, food allergies, or chronic health concerns.
If there is any other information that you think would be useful to share, please specify.
Should be Empty: