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East Coast Conference

Treasure Hunt Bible Adventure Registration Form
(One form per child)

Cost:      $10 per child or $15 per family


Child's Name               Age 

1999 Grade completed           

Parent's or Guardian's Name  

Home Phone #   (-          Work Phone #  ( -


City                State             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   _________________________________________          Date  ________________

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."

Thank You !  We look forward to seeing you !