Hero Hotline VBS - Church of the Covenant-   Child Registration
ONLINE REGISTRATION IS CLOSED
If you are interested in attending VBS, please email churchofcov.vbs@gmail.com for availability.

July 17 - 21
9:00 a.m. - 12:00 p.m.
267 East Beau St.
Washington, PA 15301
724-222-0190
churchofcov.vbs@gmail.com
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Email *
Child's Last Name *
Child's First Name (as you would like it to appear on their name tag) *
Birthdate *
MM
/
DD
/
YYYY
Current Grade Level (during 2022-2023 school year)
***Our groups for students currently in Pre-K, Kindergarten, and 4-6 grade are FULL. Please email churchofcov.vbs@gmail.com to be added to the waitlist.
 *
T-shirt Size *
Mailing Address *
Parent/Guardian 1 First and Last Name *
Parent/Guardian 1 Phone Number *
Parent/Guardian 1 Email Address *
Parent/Guardian 2 First and Last Name
Parent/Guardian 2 Phone Number
Parent/Guardian 2 Email Address
Please list the full name of ALL adults who are authorized to pick up your child from VBS. *
Does your child have any allergies or special needs?
Is there any additional information that you'd like to share with us about your child's learning style, interests, needs, etc. that will help their Group Leaders?
Are there any family members also participating in VBS? Please list their names and relation to child.
Is there a special friend that your child would like to be with at VBS? (We will try our best to accommodate all requests, but please note that children are divided into groups by age with a maximum number per group.)
Do you permit the Church of the Covenant to use any photos taken of your child during VBS for our in-church communication (Church social media accounts, website, print materials, etc.)? *
CHURCH OF THE COVENANT COVID-19 LIABILITY WAIVER AND ACKNOWLEDGMENT FORM.  I acknowledge the contagious nature of the COVID-19 virus and acknowledge The Church of the Covenant adheres to the CDC recommendations of practicing social distancing and wearing face coverings. I further acknowledge that COTC has put in place preventative measures to reduce the spread of the COVID-19 virus, to the best of their abilities. I further acknowledge that no guarantee exists regarding whether or not I or my child(ren) may contract COVID-19. I understand that the risk of becoming exposed to and/or infected by the COVID-19 virus may result from the actions, omissions, or negligence of myself and others, including but not limited to, paid staff, volunteers and others. I hereby release and agree to hold COTC, employees, and volunteers harmless from any causes of action, claims, demands, damages, costs, expenses, and compensation for damage to myself or child(ren) that may be caused by any act, or failure to act, or that may otherwise arise in any way while I or my child(ren) am participating in COTC missions, activities or meetings. I fully understand that this release discharges the aforementioned from any liability with respect to bodily injury, illness, death, medical treatment, or property damage that may arise from, or in connection to my participation as described above.     ***BY TYPING MY FULL NAME BELOW, I acknowledge that I have read the above COTC COVID-19 LIABILITY WAIVER AND ACKNOWLEDGMENT, I fully understand its terms, and I knowingly and voluntarily agree to be bound by its terms. *
By checking the box below, I understand that, given the ever-changing nature of the COVID-19 virus and corresponding recommendations surrounding virus mitigation, the preventative measures put in place by the COTC to reduce the spread of the COVID-19 virus are subject to change from time to time. If the CDC no longer recommends, and the COTC will no longer adhere to, the practices of social distancing and face covering referenced in the above COTC COVID-19 LIABILITY WAIVER AND ACKNOWLEDGMENT, I will be notified prior to the start of the VBS program. *
Required
We kindly request a $10 donation to assist with the programming costs of VBS if your family is financially able.
A copy of your responses will be emailed to the address you provided.
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