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!
Sign in to Google to save your progress. Learn more
Name
Grade Entering in Fall 2019
Birthday
MM
/
DD
/
YYYY
T-Shirt Size (adult sizes)
Clear selection
I commit to attending the mandatory training day on June 23 from 10:30-1pm at UCCN
Clear selection
Parent/Guardian Name(s)
Parent/Guardian Address(es)
Parent/Guardian Email(s)
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? *
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.
I give my permission to use photos of my child for use in publicity for UCC Norwell.
Clear selection
My child is permitted to be picked up by the following people:
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms