Register for VBS

Family Information

Address

Primary Phone

Alternate Phone

Relationship to Student Father Mother Grandfather Grandmother Great-grandfather Great-grandmother Brother Sister Uncle Aunt Guardian Foster Parent Granduncle Grandaunt Other

Phone Number

How did you hear about Summer Blast? ------ I attend DCCC DCCC website Church banner Flyer Social media Word of mouth

By checking the box here, I state that I have read and understood the terms and conditions. Authorization of Consent to Participation of Minor: I or we, the undersigned, hereby give permission for my child(ren) to participate in the summer program at Davis Chinese Christian Church (DCCC) from June 22-26, 2026. I agree that my child(ren) will fully comply with all rules and directions communicated to them or to me from DCCC. Authorization of Consent to Treatment of Minor: I or we, the undersigned, parent/guardian agree and consent to have any and all representatives and leaders working with DCCC secure any medical care or treatment deemed necessary for my child by a qualified medical examiner during the DCCC program. I further assume all responsibility for the decision so made, and for the emergency care treatment so secured for my child(ren). Authorization of Consent to Photographic or Video Use of Minor: I or we, the undersigned, also give my permission for photographs and videos of my child(ren) to be in any publication produced by DCCC, including web-based publications. Release of Davis Chinese Christian Church: I or we, the undersigned, hereby release and agree to hold DCCC and any and all representatives and leaders working with DCCC harmless from any and all causes of action, claims, demands, damages, costs, expenses and compensation that may arise from any act or failure to act by DCCC in connection with program that the minor participates in. I or we, the undersigned, understand that this release forever discharges DCCC and any and all representatives and leaders working with DCCC from any liability or claim that I or we, the undersigned, may have, including but not limited to any bodily injury, illness, death, medical treatment, or property damage that may arise from, or in connection to, the minor’s participation in the program held by DCCC. I or we, the undersigned, further agree to indemnify and hold harmless DCCC and any and all representatives and leaders working with DCCC from any other sums or liability, the assertion of liability, or any claim or action founded thereon, arising or alleged to have arisen out of the minor’s use of real or personal property belonging to DCCC. Davis Chinese Christian Church Waiver & Release Agreement

Today's Date

Student Information

Gender

Birth Date

Age Group

T-shirt size XS S M L XL

Medical Concerns

Details

Food Allergies

Details

We will be providing snacks/lunch. If your child has a food allergy or dietary restrictions, please pack appropriate daily snacks/lunch for them, as we cannot accommodate for specific dietary needs.

I will submit the registration fee through:

REGISTRATION Cost: Early bird $90 by 4/26. After 4/26 to 5/31/26 1 child, $120 2 children, $200 3 children, $300 Cancellation policy: A full refund will be given if cancellation is made prior to May 31st, 2026. PAYMENT METHODS 1. Venmo: send to @SummerBlastDCCC with camper(s)' names in the memo. 2. Cash/Check: Checks should be made out to Davis Chinese Christian Church with "2026 Summer Blast" and the camper(s)' names in the memo line. The registration fee can be dropped off in the DCCC foyer registration box, or mailed to: Davis Chinese Christian Church (c/o 2026 Summer Blast), 536 Anderson Road, Davis, CA 95616. Registration is not complete until payment is received.

I have more students to register