Children, Youth and Music Ministries Family Registration and Indemnification Form 2023-2024

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Information provided here is confidential.

First Church is consolidating paperwork! Please fill out information for your entire family on this single form to register for all Children, Youth and Music Ministries programs.

Guardian Name: *

Cell Phone: *

Work Phone:

Guardian Name:

Cell Phone:

Work Phone:

Home Phone:

Address: *

Family E-mail(s): *

Other Emergency Contact & Phone:

Minor Name: *

Date of Birth: *

Preferred Pronouns (she/her; he/him; they/them; etc.): *

Grade: *

List any allergies (food, bees, medications, etc.), health diagnoses, and/or medications:

COVID-19 Vaccinated (yes or no): *

Minor Name:

Date of Birth:

Preferred Pronouns:

Grade:

List any allergies, health diagnoses, and/or medications:

COVID-19 Vaccinated (yes or no):

Minor Name:

Date of Birth:

Preferred Pronouns:

Grade:

List any allergies, health diagnoses, and/or medications:

COVID-19 Vaccinated (yes or no):

Any additional notes:

The following child(ren) would like to participate in Music/Choir Programs:

I give permission for my child’s photo to be taken by Church staff or volunteers during activities. *

Yes

With the understanding that pictures might be used in First Church or community publications. Note that First Church does not control the taking of photographs by other participants.

Signature *

I have read the above form and by checking the box, sign and indicate my agreement with its terms. I agree that checking the box will be the electronic representation of my signature for all purposes on this document just the same as a pen and paper signature.

Note: No refunds will be issued for any family who has paid any deposit, or in full, and cancels out of any Junior or Senior High Fellowship event or trip .

Date *

Today's date

Guardians, are you member(s) of First Church? (Yes/No)

Are you interested in membership?

Yes

If not at First Church, does your family worship elsewhere?

Please type in the area(s) below in which EACH GUARDIAN would be willing to help occasionally or regularly:

Help with Children's Programs: Teacher, Shepherd, Infant/toddler care, Preschool, Supplies, VBS, Summer teacher, Seasonal events

Help with Music Programs: Children/youth choirs, Bell choir, Transportation, Choir Camp

Help with Youth Programs: Chaperone events, Transportation, Provide snacks

I, *

am the parent or guardian having legal custody of

name(s) *

who is/are, with my permission, enrolled in one or more First Church of Christ, Congregational, Glastonbury ("First Church") church school, youth fellowship or choir programs (the "Programs").

Medical Treatment

I hereby authorize the applicable employee 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 over the counter medication and assisting in administering such minor’s prescription medications as needed, (ii) 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 (iii) 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.

Indemnification and Release

On behalf of the minor listed above, 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 Programs 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.

Transportation

I give First Church permission to arrange necessary related transportation for such minor.

Parent/Legal Guardian *

Legal signature

Physician's Name & Phone Number

Preferred Hospital*

*The signer acknowledges that First Church does not guarantee that the preferred hospital will be utilized.

Insurance Carrier & Group #/ID *

Name of Insured *

*For Grades 6-12 only:

Youth Email:

Youth Cell Phone:

What are 3 things you would like to do in Fellowship this year?

*For Grades 9-12 only:

Were you Confirmed here? (Yes, No, N/A)

Are you planning to go on the Senior High Mission Trip April 7-13, 2024? (Yes, No)

By submitting this form, you accept the Mollom privacy policy.

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Children, Youth and Music Ministries Family Registration and Indemnification Form 2023-2024

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FIRST CHURCH OF CHRIST CONGREGATIONAL
Glastonbury, Connecticut

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Search form

Learning

Children, Youth and Music Ministries Family Registration and Indemnification Form 2023-2024

Primary tabs

FIRST CHURCH OF CHRIST CONGREGATIONALGlastonbury, Connecticut

FIRST CHURCH OF CHRIST CONGREGATIONAL
Glastonbury, Connecticut