VBS: CC 2026 Little Lights, Big Faith

Monday, June 15th – Friday, June 19th
8:45 am – 12:15 pm
Ages 3 (potty trained) – rising 6th graders

FPC Davenport Address: 1702 Iowa St Davenport IA 52803

Questions? cefy@fpcdavenport.org

Child's Name

Date of Birth

Age

Please select one option.

3 4 5 6 7 8 9 10 11 12 13 Youth Volunteer

Grade Entering

Please select one option.

PK K 1 2 3 4 5 6 Youth Volunteer

Parent / Guardian Name

Address

Phone

This address will receive a confirmation email

Emergency Contact

Emergency Contact Phone Number

How Did You Hear About VBS: CC:

Home Church

T-Shirt Size (all youth sizes)

Please select one option.

XS S M L XL Other (we will be contact if this is chosen)

PHOTO / VIDEO RELEASE

I hereby authorize and give full consent to First Presbyterian Church of Davenport to capture and publish any photographs or videos in which the above named student, parent(s), or grandparent(s) appear while participating in our VBS: CC program as long as they are not identified by name.

Consent for Photo / Video

Please select one option.

Yes No

EMERGENCY INFORMATION AND MEDICAL AUTHORIZATION

Purpose of the following information: To enable parents and guardians to authorize the provision of emergency treatment for children who become ill or injured while under church authority, when parents or guardians cannot be reached. In the event reasonable attempts to contact me have been unsuccessful, I hereby give my consent for: The administration of any medical treatment deemed necessary by a licensed physician or dentist and transferred to any hospital reasonably accessible.

Allergies, Dietary Concerns or other information that would be helpful for VBS: CC staff to be alerted:

Please type name and date to consent to the above information and register child for VBS: CC.

Name and Date

Description

Monday, June 15th – Friday, June 19th
8:45 am – 12:15 pm
Ages 3 (potty trained) – rising 6th graders

FPC Davenport Address: 1702 Iowa St Davenport IA 52803

Questions? cefy@fpcdavenport.org

VBS: CC 2026 Little Lights, Big Faith

Description

Please Fix the Following