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Faith Chapel Reformed Church Summer Program Application




CHILD’S NAME:______________________________________________________ Date of Birth :_____________________
GENDER (circle one): Male or Female / SCHOOL:_____________________________ GRADE ENTERING________
PARENT/GUARDIAN NAME(S):________________________________________________________________________
ADDRESS:_________________________________ CITY_________________________ STATE:________ ZIP__________
PHONE (HOME)____________________________(CELL)_________________________ (E-MAIL)___________________
Do you have family or close friends who are members of Faith Chapel? ______YES ________NO
(If yes, please list the names below. If no, how did you hear about the program?)

Does the child have any known medical conditions? ______YES ________NO

Allergies? _______YES ________NO
(Please explain any medical conditions and specify medications that the child is taking)

Is there other pertinent information regarding the child that we should know? (Explain briefly)

We are excited about the 5th year of our Summer Program (formerly the VBS Day Program)!
Faith Chapel Reformed Church has offered parents a safe, healthy and fun filled environment for their children for the past four summers and this summer we are extending our summer program to seven weeks.
From this program, The Faith Chapel Drum Line was developed and has performed for the “National Night Out” for the past two years. The Drum Line will be performing again this year and has also been asked to perform at the
closing ceremonies for the Paterson Parks and Recreation this summer.

The Faith Chapel Reformed Church Summer Day Program will offer an assortment of experiences guaranteed to meet the needs of all children. The staff is dedicated to providing all children with quality programs and activities that focus on developing the whole child. Children will learn to socialize, cooperate, make decisions, build self- esteem, challenge themselves and above all engage in Christ centered activities that teach them who God is through Jesus Christ. The children will have the opportunity to explore unique indoor and outdoor experiences that will last a lifetime.

We would like to schedule a time to meet with the parent/guardian and child to further discuss
our summer day program. Please list additional contact information below:

Parent/Guardian Name :______________________________________________________

Parent/Guardian Signature:____________________________________________________
Today’s Date:_________________________________
What is the best time to reach you? ______Day ______Afternoon _____ Evening
How can we contact you? (please list a working phone number and/or e-mail address below)
Phone__________________________________ E-mail ___________________________

Thank you for completing the 2021 FCRC Summer Program Application.

We will be in touch with you soon!

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