Hunt Bible Adventure Registration Form
(One form per child)
Cost: $10 per child or $15 per family
1999 Grade completed
Parent's or Guardian's Name
Home Phone # () - Work Phone # ( ) -
Zip Code -
Does your child attend church school? Yes No
If so, where?
List any physical/learning limitations, drug
sensitivities, allergies, or other medical conditions we should know about:
My child has permission to attend the Treasure Hunt
Bible Adventure at the Covenant Congregational Church of Cromwell. I understand that
every effort will be made to protect and safeguard all participants. Therefore, I
agree not to hold the Covenant Congregational Church or any of its staff and officers
liable for any illness or mishap occurring during the event. In the event of any
accident, injury, or illness in which it is impossible to contact me for authorization of
medical treatment, I authorize the adult chaperones, including church staff members, to
seek the proper treatment for my son/daughter. I give my permission for the use of
any form of treatment which is deemed necessary by attending nurses and physicians.
I also authorize transportation of my child by either private vehicle or ambulance in
order to facilitate any necessary treatment.
Signature of parent or guardian
This form can be submitted through E-mail,in which case
you will be required to sign the form and submit payment when you arrive at the church on
June 28th. You may also print out the form, sign and date it, and either send it
with payment or fax it to Covenant Congregational Church, 82 Hicksville Road, Cromwell, CT
06416. The fax number is (860) 635-3552. Checks should be made payable
to "Covenant Church."