VBS Registration

July 18 - 22, 2022

Dinner 5:00 - 5:45 PM

Program 6:00 - 8:00 PM

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Thank You, we have received your form.
    July 18 - 22, 2022
    @5:00 - 8:00 PM
    Attendee
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  • Parent / Guardian
    Parents, please fill the below are out.
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  • Home Church

  • How did you hear about Union VBS?

  • I would like to volunteer

  • Will you be attending the closing program on Friday and stay for the dinner?

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  • Emergency Contact

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  • Health Insurance Company

  • Policy #

  • Policy Holder's Name

  • Primary Care Physician

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  • Registration Fee is $10 per Family

  • or checks may be made payable to Union Church and sent to:

    Union Church of Robinson Township

    6165 Steubenville Pike

    McKees Rocks, PA 15136

    Please note VBS and child(ren)'s name in the memo section of your check

  • Attendee
    Please complete all fields below
  • Gender

  • Grade in Fall (2022-2023)

  • T-Shirt Size

  • Is there any non-medical information we should know about your child, such as emotional issues or custody arrangements, that would help us keep your child safe and to hel your child have a good experience at VBS?

  • Medical Concerns (please check all that apply)

  • Allergies: Please list allergies (latex, medicines, foods, environmental, etc.)

  • Medications

    Please list all medicines (over the counter and prescribed) that child will be bringing to VBS. Please include asthma inhalers and EpiPens. All medications must be listed and checked in with the VBS Leaders.

  • Waiver

    I approve the preceding application and the conditions listed below. I have written any necessary information concerning our family and our child.

    • I understand that my child will be engaging in supervised, sports related activities that may expose him/her to the possibility of accidents and I give my permission for my child's participation in these activities except as otherwise specified in writing.
    • I specifically assume all risks and hazards associated with my child(ren)'s participation in events and services included, but not limited to, the risks associated with the COVID-19 virus.  I understand that I may be associating with staff, volunteers, and other congregants and may contract COVID-19 or other viruses and diseases through my child(ren)'s participation in VBS.
    • In case of serious illness or injury I hereby give permission for medical care by physicians and/or hospital chosen by one of the VBS Leaders.  I understand that every effort will be made to contact parent/guardian in case of emergency.
    • In the event of a minor illness or injury, my child will receive basic First Aid. Such minor care may include the administration of over the counter medications including TYLENOL, BENADRYL, SPRAY CREAM, ANTIBIOTIC OINTMENT, or TOPICAL LOCAL ANESTHETIC SPRAY (e.g. SOLARCAIN, BACTINE). If a medication is administered, I will be notified by telephone and/or written First Aid Report.
    • I consent to the use of photos or video clips of my child for use in church publicity deemed appropriate by the DiscipleShip Committee including, but not limited to, Union Church website, brochures, mailings, etc.
  • Clear Signature
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