UCC Norwell Vacation Bible Camp Youth Volunteer Registration
If you have any questions or concerns, please contact our Associate Pastor, Rev. Ashley Popperson (apopperson@gmail.com). We're so glad you're joining us for camp!
Name
Your answer
Grade Entering in Fall 2019
Your answer
Birthday
MM
/
DD
/
YYYY
T-Shirt Size (adult sizes)
I commit to attending the mandatory training day on June 23 from 10:30-1pm at UCCN
Parent/Guardian Name(s)
Your answer
Parent/Guardian Address(es)
Your answer
Parent/Guardian Email(s)
Your answer
Parent/Guardian Phone Number(s) (include cells)
Your answer
Health Insurance Company, Policy or Group Number, Phone Number for Health Insurance Co.
Your answer
Doctor's Name and Phone #
Your answer
Dentist's Name and Phone #
Your answer
Please list any allergies or illnesses
Your answer
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? *
Emergencies
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.
Your answer
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:
Your answer
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