Skip directly to content

VBS Registration Form

First Church of Christ, Congregational 
Vacation Bible School 
Registration Form 
July 31 - August 4, 2017 
8:45 a.m. to noon 

 

Please click the link below to complete payment for Vacation Bible School and then complete the form below and submit to register for Vacation Bible School.

Submit Payment

 

Name of child
*(child must be 4 yrs old by 8/1/2016 to participate)
Name of child
*(child must be 4 yrs old by 8/1/2016 to participate)
Name of Child
*(child must be 4 yrs old by 8/1/2016 to participate)
Parent/Guardian
Residential
Home
Mobile
Other
Please leave name, phone, etc.
Please leave name, phone, etc.
Name the person(s) who may pick up this child from VBS each day
Please indicate any specific concerns about your child’s allergies, medical concerns, cognitive disabilities, history of trauma or abuse, behavioral diagnosis, etc… including if they will carry epi-pens or inhalers.
VBS is run by an all-volunteer staff, so we encourage all parents to get involved in some way. We have opportunities working in stations, check-in, activity prep work, clean-up hour at end of day, taking pictures, etc. If you are able to help, please indicate your availability/preference.

The First Church of Christ, Congregational, Glastonbury Indemnification, Release, and Medical Treatment Consent Form Vacation Bible School

I acknowledge that I am the parent or guardian having legal custody of this (these) above listed child (children), a minor(s), ages (as listed), born on the above date (dates), who is (are), with my permission, enrolled in The First Church of Christ, Congregational, Glastonbury's ("First Church") Vacation Bible School (the "Program").

I hereby authorize the Director of Christian Education of First Church or any other adult acting as an agent or representative of First Church to take any and all actions that may be necessary or proper to provide for, or arrange for the provision of, the health care of such minor, including, but not limited to, (i) providing for such health care at any hospital or other institution, or employing any physician, dentist, nurse, or other person for such health care, and (ii) consenting to and authorizing any health care, including but not limited to the administration of anesthesia, the taking of X-rays, the performance of tests and operations, and other procedures, by physicians, dentists, nurses, and other medical personnel. I agree to be responsible for any and all charges incurred in connection with any care or treatment rendered pursuant to this authorization, even if an employee, agent or representative of First Church has signed documentation promising to pay for such care or treatment.

On behalf of the minor listed above, the minor's parents and/or legal guardians, I agree to defend, hold harmless, indemnify and release First Church and its officers, trustees, employees, agents, representatives, volunteers, and all others who are involved in the Program from and against any and all claims, demands, actions, or causes of action of any sort on account of damage to personal property, or personal injury, or death which may result from such minor's participation in the Program. This release includes claims based on the negligence of First Church and its officers, trustees, employees, agents, representatives, and volunteers, but expressly does not include claims based on their intentional misconduct or gross negligence.

Name and phone number of physician
*The signer acknowledges that First Church does not guarantee that the preferred hospital will be utilized.
Legal signature
By submitting this form, you accept the Mollom privacy policy.