MCC VBS 2023 Counselor Application

June 19-June 23, 9:00am-12:00 pm | This is the application to be a counselor for MCC's Vacation Bible School.
Please fill out this form and click submit. Questions can be sent to vbeard@middleburyucc.org

Counselor Name

Counselor Email

This address will receive a confirmation email

Counselor Phone

Address

Birthdate

Grade (2023-24 school year)

Please select one option.

7 8 9 10 11 12 college

Parent/Guardian name

Parent/Guardian Phone

Parent/Guardian Email

Tell us about why you'd like to be a counselor at MCC's VBS:

Does your child have any allergies, medical conditions, or special needs we should know about? If so, please describe and include any accommodations necessary.

Emergency Contact: Name, relationship, phone number

Person Responsible for pick-up

Permissions: Photos may taken and be used for: bulletin boards, publications (Church newsletters, newspaper), MCC website and/or Social Media.

Please select one option.

Parent acknowledges and agrees

End of week show may be livestreamed/recorded for families to view. Children may appear in video

Please select one option.

Parent acknowledges and agrees

My child/children has permission to participate in the MCC VBS events between June 19 and June 23 2023. I understand that I may not hold MCC liable in case of accident or injury to my child. I give permission for medical care to be given should my child need treatment before I am contacted.

Please select one option.

Parent acknowledges and agrees

Description

June 19-June 23, 9:00am-12:00 pm

This is the application to be a counselor for MCC's Vacation Bible School.
Please fill out this form and click submit. Questions can be sent to vbeard@middleburyucc.org

MCC VBS 2023 Counselor Application

Description

Please Fix the Following