UCC Norwell Vacation Bible Camp Youth Volunteer Registration
If you have any questions or concerns, please contact our Associate Pastor, Rev. Ashley Popperson (
). We're so glad you're joining us for camp!
Grade Entering in Fall 2019
T-Shirt Size (adult sizes)
I commit to attending the mandatory training day on June 23 from 10:30-1pm at UCCN
I cannot and I will follow up with Ashley about an alternative training day.
Parent/Guardian Phone Number(s) (include cells)
Health Insurance Company, Policy or Group Number, Phone Number for Health Insurance Co.
Doctor's Name and Phone #
Dentist's Name and Phone #
Please list any allergies or illnesses
Would you like our Associate Pastor to contact you regarding specific medical, learning, or social considerations that would help your child participate and thrive in our programs?
Electronic signature below implies consent to treat.
Emergencies: In the event that I am unable to be reached, I/we the parent(s)/guardian(s) of the above child hereby authorize adult volunteers of UCCN as agents for the undersigned, to consent to any medical or surgical care deemed advisable by an accredited physician or surgeon in an approved emergency clinic or hospital. I further release from any liability UCC Norwell, any ministries or leaders in the event of an accident before, during or after Church School. This agreement does not apply to claims for intentional misconduct or gross negligence.
I give my permission to use photos of my child for use in publicity for UCC Norwell.
My child is permitted to be picked up by the following people:
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