Registration Form
Below you will find the necessary documents to fill out in order to register your children for Vacation Bible School at Christian Pentecostal Church of Newton. Although the form appears lengthy, we ask that you take the time to fill out all the necessary information. We include thorough detail in order to cover all possible emergencies or unexpected situations. We ask that you copy this complete document fill it out by hand or electronically and return it to CP Church via email or snail mail (provided on our contact page). For your comfort, please know that we will have several staff on site certified in CPR and First Aid. We will also have a nurse and paramedic on site on a few of the days of VBS. If there are any further concerns regarding medical care, please note it on your registration form. We are here for you to care for your child in the best way possible.
If you have any questions, please feel free to contact us through our contact page. Thank you!
If you have any questions, please feel free to contact us through our contact page. Thank you!
Christian Pentecostal Church
Vacation Bible School
High Seas Expedition
Child's Information
Child's Name:
___________________________________________________________________________________________________________________
Nickname:
___________________________________________________________________________________________________________________
Address:
___________________________________________________________________________________________________________________
Child's Date of Birth/Age:
___________________________________________________________________________________________________________________
Is CPC your home church?
___________________________________________________________________________________________________________________
Which days do you plan for your child to attend Vacation Bible School with us?
___________________________________________________________________________________________________________________
Parent Information
Parent/Guardian Name:
___________________________________________________________________________________________________________________
Address:
___________________________________________________________________________________________________________________
Home Phone Number:
___________________________________________________________________________________________________________________
Daytime Phone Number:
___________________________________________________________________________________________________________________
Email Address:
___________________________________________________________________________________________________________________
Is CPC your home church?
___________________________________________________________________________________________________________________
Emergency Contact Information
Primary Emergency Contact:
Name:
___________________________________________________________________________________________________________________
Address:
___________________________________________________________________________________________________________________
Telephone:
___________________________________________________________________________________________________________________
Relationship to Child:
___________________________________________________________________________________________________________________
Secondary Emergency Contact:
Name:
___________________________________________________________________________________________________________________
Address:
___________________________________________________________________________________________________________________
Telephone:
___________________________________________________________________________________________________________________
Relationship to Child:
___________________________________________________________________________________________________________________
Are there any custody issues we should be aware of in releasing your child at the end of each day?
___________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________
Health and Medical Conditions
Please list any allergies or medical conditions your child has:
___________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________
Does your child carry an Epi-Pen or other medications for allergies/medical conditions? If so, please let us know the circumstances in which this will need to be used. (Note: We have several people on site with CPR training and first aid training, as well as a nurse and paramedic who will be on site throughout most of the week.):
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
Does your child have any physical needs/ailments that would prevent them from participating in physical activity?
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
Child's Name:
___________________________________________________________________________________________________________________
Nickname:
___________________________________________________________________________________________________________________
Address:
___________________________________________________________________________________________________________________
Child's Date of Birth/Age:
___________________________________________________________________________________________________________________
Is CPC your home church?
___________________________________________________________________________________________________________________
Which days do you plan for your child to attend Vacation Bible School with us?
___________________________________________________________________________________________________________________
Parent Information
Parent/Guardian Name:
___________________________________________________________________________________________________________________
Address:
___________________________________________________________________________________________________________________
Home Phone Number:
___________________________________________________________________________________________________________________
Daytime Phone Number:
___________________________________________________________________________________________________________________
Email Address:
___________________________________________________________________________________________________________________
Is CPC your home church?
___________________________________________________________________________________________________________________
Emergency Contact Information
Primary Emergency Contact:
Name:
___________________________________________________________________________________________________________________
Address:
___________________________________________________________________________________________________________________
Telephone:
___________________________________________________________________________________________________________________
Relationship to Child:
___________________________________________________________________________________________________________________
Secondary Emergency Contact:
Name:
___________________________________________________________________________________________________________________
Address:
___________________________________________________________________________________________________________________
Telephone:
___________________________________________________________________________________________________________________
Relationship to Child:
___________________________________________________________________________________________________________________
Are there any custody issues we should be aware of in releasing your child at the end of each day?
___________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________
Health and Medical Conditions
Please list any allergies or medical conditions your child has:
___________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________
Does your child carry an Epi-Pen or other medications for allergies/medical conditions? If so, please let us know the circumstances in which this will need to be used. (Note: We have several people on site with CPR training and first aid training, as well as a nurse and paramedic who will be on site throughout most of the week.):
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
Does your child have any physical needs/ailments that would prevent them from participating in physical activity?
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
Medical Release
I, ___________________________________________, give permission for ___________________________________________________,
(Name of Parent or Legal Guardian-please print) (Name of Child - please print)
to participate in all activities at the Christian Pentecostal Church Vacation Bible School, and authorize any medical treatment in my absence, for the well-being of my child, in case of an emergency. I agree to hold harmless Christian Pentecostal Church, and any and all volunteers of the Vacation Bible School, exclusive of negligence, from any injury or sickness which occurs during this program.
This authorization shall remain in full force and effect unless otherwise revoked in writing.
A photostatic copy of this authorization shall be as effective as the one containing my original signature.
____________________________________________________ _______________________________________________
Signature of Parent Date
***Unless otherwise specified, in the event of an emergency, your child will be brought to one of the hospitals closest to the church, Newton-Wellesley Hospital or Saint Elizabeth's Hospital.
(Name of Parent or Legal Guardian-please print) (Name of Child - please print)
to participate in all activities at the Christian Pentecostal Church Vacation Bible School, and authorize any medical treatment in my absence, for the well-being of my child, in case of an emergency. I agree to hold harmless Christian Pentecostal Church, and any and all volunteers of the Vacation Bible School, exclusive of negligence, from any injury or sickness which occurs during this program.
This authorization shall remain in full force and effect unless otherwise revoked in writing.
A photostatic copy of this authorization shall be as effective as the one containing my original signature.
____________________________________________________ _______________________________________________
Signature of Parent Date
***Unless otherwise specified, in the event of an emergency, your child will be brought to one of the hospitals closest to the church, Newton-Wellesley Hospital or Saint Elizabeth's Hospital.
Final Information:
1.We will be providing wristbands for the children, with a removable stub, with corresponding numbers. In order to pick-up your child, you will need to present the stub to your child's VBS Crew Leader at the end of each VBS day.
2. The only person authorized to pick-up your child is the individual who has the ticket stub. If you lose your ticket stub, you will be asked to verify your identity with a picture ID.
3. Please be advised that we will not release your child to anyone who is not named on the Registration form without prior notification. These individuals may also be asked for photo identification.
4. The children will be provided with snack and water during the day. If there are certain foods you do not wish your child to consume (aside from foods to which he/she is allergic), please speak with your child's VBS Crew Leader.
5. Please note that Vacation Bible School ends at 12:00 p.m. and your child must be picked up at that time. You, as the parent/legal guardian, must be present yourself to pick up you child or schedule someone whom we have been notified of to pick up your child.
Acknowledgment
I, _______________________________________________________, have read and completed the VBS Registration Form to the best of my ability and understand and agree with its contents. I have provided the VBS Crew with information relating to my child (allergies, medical conditions, etc) and understand that they will use their best judgment in the event of an emergency.
This authorization shall remain in full force and effect unless otherwise revoked in writing.
A photostatic copy of this authorization shall be as effective as the one containing my original signature.
______________________________________________________ ________________________________________________
Signature of Parent Date
1.We will be providing wristbands for the children, with a removable stub, with corresponding numbers. In order to pick-up your child, you will need to present the stub to your child's VBS Crew Leader at the end of each VBS day.
2. The only person authorized to pick-up your child is the individual who has the ticket stub. If you lose your ticket stub, you will be asked to verify your identity with a picture ID.
3. Please be advised that we will not release your child to anyone who is not named on the Registration form without prior notification. These individuals may also be asked for photo identification.
4. The children will be provided with snack and water during the day. If there are certain foods you do not wish your child to consume (aside from foods to which he/she is allergic), please speak with your child's VBS Crew Leader.
5. Please note that Vacation Bible School ends at 12:00 p.m. and your child must be picked up at that time. You, as the parent/legal guardian, must be present yourself to pick up you child or schedule someone whom we have been notified of to pick up your child.
Acknowledgment
I, _______________________________________________________, have read and completed the VBS Registration Form to the best of my ability and understand and agree with its contents. I have provided the VBS Crew with information relating to my child (allergies, medical conditions, etc) and understand that they will use their best judgment in the event of an emergency.
This authorization shall remain in full force and effect unless otherwise revoked in writing.
A photostatic copy of this authorization shall be as effective as the one containing my original signature.
______________________________________________________ ________________________________________________
Signature of Parent Date
Christian Pentecostal Church 150 Lowell Avenue Newtonville, MA 02458
