Confirmation Registration

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					           General Registration Form

Parents, please complete the following registration form
for your confirmand. This form is used to help us know
general information about you and your child.

We will use this information to order your child’s church
nametag, retreat t-shirt, and to fill out all certificates your
child receives.
                            Confirmation Class of 2011
                             th
                           6 Graders-Registration Form
    **All Confirmands must have a fully completed registration form. Please read carefully!!**


Full Name (as you want it to appear on all certificates):
____________________________________________________________________________

Name you prefer to be used conversationally (if different from above):
____________________________________________________________________________
Address: ______________________________________________________________________

City: ____________________________________________Zip Code:____________________

Home Phone #: ________________________________________________________________

Mother’s name: ____________________________ Work/Cell #:_________________________

Father’s name:_____________________________ Work/Cell #: _________________________

Parent’s E-mail: _______________________________________________________________

Confirmand’s E-mail: ___________________________________________________________

Have you been baptized? Yes___________________________ No______________________

If yes, what church and where? ___________________________________________________

What is Confirmand’s preferred Adult t-shirt size (circle one):

Small              Medium               Large                 X-Large              XX-Large

**Church Nametag: Please print the name your child would like to be used on the name tag and
how to have it spaced**


UNDERSIGNED gives CHRIST UMC permission to take and use photographs, video recordings, or movies
of PARTICIPANT taken during an ACTIVITY for any purpose in promoting CHRIST UMC or related activities
of CHRIST UMC in print, brochures, advertisements, films or videos and on broadcast presentations of any
sort.

Signature__________________




                   Confirmation Angel Registration Form
            What is a Confirmation Angel? This is one person who writes to your
            child each week to encourage them in their confirmation journey.
            This person lets them know that they are praying for them and
            thinking of them every week. Letters may be mailed or dropped off
            at the church. A drop off basket will be located at the front desk of
            the annex. Letters should be mailed to:
      Child’s Name
      Attn: Janice Volkmar
      4201 State Hwy 6 South
      College Station, TX 77845
Angels will then attend Angel Dinner with your child. This is the time
when the Angel reveals themselves to the Confirmand and they
share an evening together. At this time, the Angel may present a
small token to the child if they choose to do so.

All Confirmands must have a completed Angel registration form.
Please pick someone who is willing to provide weekly support for
your child. This form is also available online at www.christ-umc.org.


Confirmands Name:____________________________

Name of Angel:________________________________

Angel’s Address: _______________________________
________________________________________________

Angel’s Phone:_________________________________

  Angel’s E-mail: _________________________________




                 Medical Release Form

Parents, please complete the following medical registration
form for your confirmand. This form is used in case of an
emergency. We need you to complete all the information
requested on this form including date of last tetanus shot
and copy of your insurance card. This form MUST be
notarized. You can come up to the church during work
hours and have a notary from the church sign your form for
free.

                   Permission Slip
                      General
                         &
         Riding in Cars with CUMC workers

Parents, please complete this form to allow your child
to participate in Confirmation activities at Christ UMC
and to allow your child to ride in a car with a CUMC
worker or volunteer. Riding in a car occurs during
field trips, retreat, and special outings.




CHRIST UNITED METHODIST MEDICAL RELEASE
FORM
CHILD’S NAME                             SEX            AGE __
CHILD’S SOCIAL SECURITY NUMBER                 D.O.B.
NAME OF PARENT/GUARDIAN
ADDRESS
CITY                                                       STATE                        ZIP
HOME PHONE                                                 WORK PHONE

Please list the name of the nearest relative/friend to be contacted in an emergency.
Name                                       Home Phone                       Work Phone
PHYSICIAN                                                                   Phone
DATE OF LAST TETANUS SHOT
INSURANCE AGENCY NAME
POLICY NUMBER                                               EXPIRATION DATE
GROUP NUMBER                                                AGENCY PHONE
           A COPY OF YOUR INSURANCE CARD MUST ACCOMPANY THIS FORM

DESCRIBE ANY HEALTH PROBLEMS OF CHILD:

ALLERGIES (drug or other):

PLEASE LIST ANY MEDICATION PRESENTLY TAKING:

LIST ANY ACTIVITIES THAT YOUR CHILD CANNOT DO:

In the event that my child                                                 becomes ill or sustains an
injury while engaged in any activity or youth trip sponsored by or associated with Christ United Methodist
Church of College Station, Texas, I, the undersigned, give my permission to those in charge, or any other
chaperone designated by the church, to take whatever steps are necessary to render care and to
administer first aid. I consent to any and all dental, medical, surgical and/or diagnostic procedures and
treatment deemed necessary by a licensed dentist, physician or surgeon. I also consent to care in a
hospital facility if necessary.

Further, in exchange for permitting the above-named child to participate in church activities, I agree to
indemnify, defend and hold harmless Christ United Methodist Church of and from any and all liability, claims,
obligations, demands, liens, judgments, penalties, fines, suits, losses, costs or causes of action of any kind
or character whatsoever, known or unknown, now accrued or which may hereafter accrue, arising from or in
any way growing out of, derivative of, connected with, or resulting or arising from any lawsuit and/or claims
that may be asserted with regard to any injuries sustained by the above-named child while engaged in a
church activity. I AGREE THAT THIS INDEMNIFICATION INCLUDES THE AMOUNT OF ANY CLAIM, THE
EXPENSES OF DEFENDING AGAINST ANY CLAIM, ATTORNEY’S FEES AND COURTS COSTS. I FURTHER
AGREE THAT THIS INDEMNITY EXPRESSLY INCLUDES ANY CLAIM ARISING OUT OF CHRIST UNITED
METHODIST CHURCH’S OWN NEGLIGENCE, FAULT, COMPARATIVE RESPONSIBILITY, BREACH OF
CONTRACT AND/OR WARRANTY.


Signature of Parent or Guardian                                    Date

                                             NOTARY STATEMENT

BEFORE ME, the undersigned authority, on this day personally appeared                        , known
to me to be the person whose name is subscribed above and acknowledged to me that he/she executed the
same for the purpose therein expressed.

SWORN AND SUBSCRIBED before me on this       day of                         , 20____.

State of Texas
                             Notary Public                                              Commission Expires




                                             PERMISSION SLIP

I (we), the parent(s), legal guardian(s), or custodian(s) of:_______________
_______________________________ a minor, have given our consent for he or
she to participate in the Confirmation Program of Christ United Methodist Church
including activities requiring him/her to ride in a car with a worker of Christ
United Methodist Church.
Dated this ____________________day of _________________20_.
Signature:_______________________________________________
Relationship:_____________________________________________

               RELEASE AND HOLD HARMLESS AGREEMENT
     CHRIST UNITED METHODIST CHURCH, COLLEGE STATION, TEXAS

Everyone participating in the Confirmation Program of Christ United Methodist
church and activities requiring a minor to ride in a car with a CUMC worker or
volunteer must read and sign the Release and Hold Harmless Agreement. This
form will be kept on file at Christ United Methodist Church and will remain in
effect for the duration of the program.
Name of child:_______________________________ Age:_____________
Name of Parent(s) or Guardian(s):_________________________________
Address:__________________________________ Phone: ______________
I (we), the parent(s), legal guardian(s), or custodian(s) of any minor participating in
the Confirmation Program of Christ United Methodist Church of College Station,
Texas, knowingly release, absolve, indemnify, and hold harmless of Christ United
Methodist church from all claims that might result from any injury and/or death of
any minor. This Release and Hold Harmless Agreement shall remain in effect for
the duration of the program.

Dated this _______________________day of__________________20__.

Signature:________________________ Relationship:________________

Signature: _______________________ Relationship: ________________




                       Spring Retreat Forms
Parents, please complete the following forms for Spring
 Retreat. Spring Retreat is a time when the Youth and
     Confirmands have fun and worship together.


1) All Confirmands must have a completed camp minor
   release in order to go to camp.
2) If you are a parent and want to come on retreat,
   please fill out the adult release form.
                  PARENT/GUARDIAN AUTHORIZATION,
           LIMITED RELEASE AND COVENANT NOT TO EXECUTE,
                        AND MEDICAL RELEASE

      Frontier Camp, Inc. requires a parent or guardian of all campers to sign this form before
the camper participates in any GENERAL CAMP ACTIVITIES or PROGRAMS,
HORSE/EQUINE ACTIVITIES, BOATING/AQUATIC ACTIVITIES, SKATEPARK ACTIVITIES
or ROPES COURSE/CHALLENGE ACTIVITIES.

        The undersigned acknowledges that, while campers attend Frontier Camp and
participate in the camp’s activities and programs, certain risks and dangers may occur. The
undersigned further recognizes that these risks may include physical, emotional or
psychological damage or injury, not excluding fatality, due to accidents that may occur or result
from any general camp activities or programs, horse/equine activities, boating/aquatic activities,
skatepark activities, or ropes course/challenge activities. The undersigned acknowledges that
Frontier Camp, Inc. may take photographs or video of the camper named below to be used in
promotional materials. The undersigned agrees to abide by all policies and procedures of
Frontier Camp, Inc. in order to maintain the utmost level of safety.

        With respect to horse/equine activities, House Bill 280 took effect on September 1, 1995,
and contains the following warning:
                                             Warning
 Under Texas law (Chapter 87, Civil Practice and Remedies Code), an equine professional
is not liable for an injury to or the death of a participant in equine activities resulting from
                             the inherent risks of equine activities.

       In consideration of the above, the undersigned, for himself or herself and on behalf of
the below-named camper in any capacity, RELEASES the directors, officers, employees, and
agents of Frontier Camp, Inc. in their individual capacities from any claim or judgment based on
negligence or other ground of liability, whether for bodily injury, property damage or loss, or
otherwise.

        In further consideration of the above, the undersigned, for himself or herself and on
behalf of the below-named camper in any capacity, COVENANTS NOT TO EXECUTE on any
asset of Frontier Camp, Inc. or of its directors, officers, employees, or agents for any judgment
or claim for negligence or otherwise. Instead, the undersigned agrees to limit the satisfaction of
any judgment to the available proceeds of any applicable insurance policy of and covering
Frontier Camp, Inc.

       The undersigned also gives permission to the staff of Frontier Camp, Inc. to administer
or obtain any MEDICAL attention or treatment of the camper named below for any illness,
accident or injury occurring or identified during the camper’s stay at Frontier Camp.
        The undersigned fully understands this form, and has the capacity to sign on behalf of
the child camper named below.

PARENT OR GUARDIAN HAVING CUSTODY OR CONTROL:

Name printed: _______________________          Signature: _________________________

Camper’s name: _______________________           Date: _______________________

                                                                              Minor Release
                            Spring Retreat Forms

Parents, please complete the following forms for Spring Retreat. Spring Retreat
  is a time when the Youth and Confirmands have fun and worship together.

 We need adults to come and help supervise the children. It is important for us
    to have both male and female adult helpers at retreat. Please prayerfully
consider being a retreat chaperone and complete the following form if you wish to
                                     do so.
               LIMITED RELEASE AND COVENANT NOT TO EXECUTE,
                          AND MEDICAL RELEASE
     Frontier Camp, Inc. requires all campers to sign this form before participating in any
GENERAL CAMP ACTIVITIES or PROGRAMS, HORSE/EQUINE ACTIVITIES,
BOATING/AQUATIC       ACTIVITIES,       SKATEPARK          ACTIVITIES       or      ROPES
COURSE/CHALLENGE ACTIVITIES.

        The undersigned acknowledges that, while campers attend Frontier Camp and
participate in the camp’s activities and programs, certain risks and dangers may occur. The
undersigned further recognizes that these        risks may include physical, emotional, or
psychological damage or injury, not excluding fatality, due to accidents that may occur or result
from any general camp activities or programs, horse/equine activities, boating/aquatic activities,
skatepark activities, or ropes course/challenge activities. The undersigned acknowledges that
Frontier Camp, Inc. may take photographs or video of the camper named below to be used in
promotional materials. The undersigned agrees to abide by all policies and procedures of
Frontier Camp, Inc. in order to maintain the utmost level of safety.

        With respect to horse/equine activities, House Bill 280 took effect on September 1, 1995,
and contains the following warning:
                                             Warning
 Under Texas law (Chapter 87, Civil Practice and Remedies Code), an equine professional
is not liable for an injury to or the death of a participant in equine activities resulting from
                             the inherent risks of equine activities.

       In consideration of the above, the undersigned, for himself or herself and on behalf of
the below-named camper in any capacity, RELEASES the directors, officers, employees, and
agents of Frontier Camp, Inc. in their individual capacities from any claim or judgment based on
negligence or other ground of liability, whether for bodily injury, property damage or loss, or
otherwise.

        In further consideration of the above, the undersigned, for himself or herself and on
behalf of the below-named camper in any capacity, COVENANTS NOT TO EXECUTE on any
asset of Frontier Camp, Inc. or of its directors, officers, employees, or agents for any judgment
or claim for negligence or otherwise. Instead, the undersigned agrees to limit the satisfaction of
any judgment to the available proceeds of any applicable insurance policy of and covering
Frontier Camp, Inc.

       The undersigned also gives permission to the staff of Frontier Camp, Inc. to administer
or obtain any MEDICAL attention or treatment of the camper named below for any illness,
accident or injury occurring or identified during the camper’s stay at Frontier Camp.

       The undersigned fully understands this form, and has the capacity to sign it.


Signature:     _____________________________                 Date: _________________


Camper’s name printed: ________________________________



                                                                                 Adult Release




                                Medical Release Form
Anyone participating in an off campus CUMC event must complete this form and have it
on file with the church. Parents, if you plan to help with the service project, field trips, or
 a retreat you must complete this form. You do not have to include your Social Security
# if you don’t feel comfortable doing so. However, please complete as much of the form
                   as you can so that you can get help in an emergency.
CHRIST UNITED METHODIST MEDICAL RELEASE FORM

 NAME                                                      SEX             AGE
 SOCIAL SECURITY NUMBER                                           D.O.B.
 ADDRESS
 CITY                                                      STATE                    ZIP
 HOME PHONE                                                WORK PHONE

 Please list the name of the nearest relative/friend to be contacted in an emergency.

 Name                                     Home Phone                       Work Phone

 PHYSICIAN                                                                 Phone
 DATE OF LAST TETANUS SHOT
INSURANCE AGENCY NAME
POLICY NUMBER                                             EXPIRATION DATE
GROUP NUMBER                                              AGENCY PHONE


DESCRIBE ANY HEALTH PROBLEMS:

ALLERGIES (drug or other):

PLEASE LIST ANY MEDICATION PRESENTLY TAKING:

LIST ANY ACTIVITIES THAT YOU CANNOT DO:

In the event that I,                                              , becomes ill or sustains an injury while
engaged in any activity or youth trip sponsored by or associated with Christ United Methodist Church of
College Station, Texas, I, the undersigned, give my permission to those in charge, or any other
chaperone designated by the church, to take whatever steps are necessary to render care and to
administer first aid. I consent to any and all dental, medical, surgical and/or diagnostic procedures and
treatment deemed necessary by a licensed dentist, physician or surgeon. I also consent to care in a
hospital facility if necessary.

Further, in exchange for permitting the above-named person to participate in church activities, I
agree to indemnify, defend and hold harmless Christ United Methodist Church of and from any
and all liability, claims, obligations, demands, liens, judgments, penalties, fines, suits, losses,
costs or causes of action of any kind or character whatsoever, known or unknown, now accrued
or which may hereafter accrue, arising from or in any way growing out of, derivative of, connected
with, or resulting or arising from any lawsuit and/or claims that may be asserted with regard to
any injuries sustained by the above-named child while engaged in a church activity. I AGREE
THAT THIS INDEMNIFICATION INCLUDES THE AMOUNT OF ANY CLAIM, THE EXPENSES OF
DEFENDING AGAINST ANY CLAIM, ATTORNEY’S FEES AND COURTS COSTS. I FURTHER AGREE
THAT THIS INDEMNITY EXPRESSLY INCLUDES ANY CLAIM ARISING OUT OF CHRIST UNITED
METHODIST CHURCH’S OWN NEGLIGENCE, FAULT, COMPARATIVE RESPONSIBILITY, BREACH
OF CONTRACT AND/OR WARRANTY.


Signature of Participant                                         Date




                           Proof of Insurance Forms

In order to drive children in your private vehicle related to
Christ UMC ministry events, you are required to complete
the “Statement of Insurance on Private Vehicles” form. This
will allow you to serve by providing transportation.
If you are willing to drive children in your vehicle for CUMC
events (service project, field trips, spring retreat, etc.) please
complete this form for us to keep on file. A copy of your
driver’s license and vehicle insurance declaration page
must accompany this form.

You will have to complete this form before children ride in
your vehicle. If you think there is a chance you will drive
more than just your child to an event, please complete this
form for us to keep on file.




     STATEMENT OF INSURANCE ON PRIVATE VEHICLES

Christ United Methodist Church
4201 State Hwy 6 S
College Station, Texas 77845
979 690 4673 fax 979 690 6098
CUMC requires proof of insurance in force on all private vehicles, prior to and during their use
for the transportation of CUMC sponsored trips on all in-county and out-of-county trips. The
groups being transported include, but are not limited to, students, parents, teachers, staff, and
volunteers.

This form is to be completed for each private vehicle used.

Date _______________________                   Driver’s name ________________________

Age ________________________                   Driver’s License Number _______________

This is to certify that insurance policies, subject to their terms, conditions and exclusions, are at
present in force with the company indicated.

Name of insured __________________________________________________________

Policy number ___________________________________________________________

Insurance company _______________________________________________________

Vehicle make _________________ Year _____________ Model __________________

Policy period from __________________________ to ___________________________


A photocopy of your insurance declaration page and driver’s license is required.

I certify that the above information is correct.



       Signature of insured _________________________________ Date signed ______

				
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