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N.C.I.S. 2018 Registration

***NEW*** Online registration. To register your child: 

1. Complete the Registration Form below, and hit "SUBMIT NCIS REGISTRATION."
2. Email images of your insurance card using the "CLICK TO SUBMIT INSURANCE CARD IMAGES" link below the registration form. 

3. If you wish to pay online, you may do so using the "ADD TO CART" button at the bottom and following the instructions.  

Calvary Lutheran Church’s 2018 N.C.I.S. (= New Christians in Service) is a fun-filled week of serving. Youth will work in small groups and do service projects in the West Chester community. They will also learn team building skills, cultural sensitivity and self confidence while sharing their faith.   

WHEN: July 9th to July 13th from 12:00am to 5:30pm. Space is limited! 
WHO: This exciting program is for youth who have finished 5th to 8th grades.

All youth who have completed 9th to 12th grade may serve as leaders. Please contact Nicolle Layman to discuss leadership opportunities. Click here to download and print a leadership application.

All parents of children enrolled in the NCIS Program will be required to support the program in some way. Mandatory Mtg Wed, May 23th at 7pm. Supplies will be needed for projects, transportation to and from service projects, mentoring oversight of projects and more.

Contact Wendy or Nicolle with any questions.

REGISTRATION:
Registration is open April 1 - May 31. 

PAYMENT: 
$85 per child. The registration fee includes a T-shirt and lunch each day. Scholarships available.


Registration Form

Youth 1 Name *
Youth 1 Name
Youth 1 DOB *
Youth 1 DOB
If applicable
PLEASE NOTE THAT EPI-PENS SENT IN MUST HAVE A PRESCRIPTION WITH CHILD'S FULL NAME, DATE OF BIRTH, AND PHYSICIAN'S NAME.
Youth 2 Name
Youth 2 Name
If registering second youth.
Youth 2 DOB
Youth 2 DOB
If applicable
PLEASE NOTE THAT EPI-PENS SENT IN MUST HAVE A PRESCRIPTION WITH CHILD'S FULL NAME, DATE OF BIRTH, AND PHYSICIAN'S NAME.
Youth 3 Name
Youth 3 Name
If registering third youth.
Youth 3 DOB
Youth 3 DOB
If applicable
PLEASE NOTE THAT EPI-PENS SENT IN MUST HAVE A PRESCRIPTION WITH CHILD'S FULL NAME, DATE OF BIRTH, AND PHYSICIAN'S NAME.
*************************************************************************************************************************************************************************************
Parent/Legal Guardian Name *
Parent/Legal Guardian Name
Preferred Phone During NCIS *
Preferred Phone During NCIS
Address *
Address
Driver Agreement. I am able to help as a driver, and:
(This is applicable only if you are willing to be a driver for NCIS)
If applicable
If applicable.
Emergency Contact *
Emergency Contact
At least one Emergency Contact is required
Emergency Contact Phone *
Emergency Contact Phone
Emergency Contact 2
Emergency Contact 2
Not Required
Emergency Contact 2 Phone
Emergency Contact 2 Phone
Physician Name *
Physician Name
Physician Phone *
Physician Phone
All participants are required to submit photocopies or photographs of the front and back of active insurance cards. You may email copies to Nicolle using the link below.
Subscriber Name *
Subscriber Name
Participation Permission and Liability Release Agreement *
I/We give my permission for the participant(s) named above to participate in NCIS at Calvary Lutheran Church in West Chester, Pennsylvania for the week of July 9-13, 2018. I release Calvary Lutheran Church from any and all liability to me or my child(ren) as a result of his/her participation. Also, I understand that Calvary Lutheran Church does not assume any responsibility for loss of, or damage to, personal property of the participant.
Medical Treatment Consent and Release *
I/We do hereby consent to any hospital, medical, or surgical care and treatment and the administration of anesthesia, determined by a qualified physician to be necessary for the welfare of my child(ren) while my child(ren) is under the care and custody of an adult leader of any activity sponsored by Calvary Lutheran Church of West Chester, Pennsylvania, in the event I can not reasonably be contacted for consent. I understand that I am responsible for and agree to pay all costs and expenses incurred in connection with such medical and/or dental services rendered to my child pursuant to this authorization.
Image Release Agreement *
I/We grant Calvary Lutheran Church permission to use my child(ren)'s likeness, without names, as recorded while participating in activities sponsored by Calvary Lutheran Church of West Chester, Pennsylvania, in photographs, video recordings or electronic images, in any and all of its publications, including website and social media entries, without payment or any other consideration.
Transportation Consent *
I hereby give permission for my child to ride in any vehicle designated by the adult in whose care my child has been entrusted while attending and participating in activities sponsored by Calvary Lutheran Church of West Chester, Pennsylvania. I also understand that, should my child be sent home from an event or retreat for medical or disciplinary reasons, I will be responsible for making any transportation arrangements and paying for associated costs.
Sponsorship
Help make NCIS possible for another child. Simply add the number of sponsorships to your registration number and indicate "Sponsorship" using the payment method you choose.

***NOTE***  To register your child(ren), complete the Registration Form above, and hit "SUBMIT NCIS REGISTRATION."
After registering, you must ALSO submit images of the front and back of an active insurance card using the button below.

If you wish to pay online, you may do so using the "ADD TO CART" button below and following the instructions. 


Submit Insurance Cards


Online Payment

N.C.I.S.
85.00

We now accept online credit card or PayPal payment for registrations.

  • Indicate the number of children to be registered (Quantity)
  • Click "Add to Cart" button
  • Confirm the name(s) of registrants

Check or Cash Payments:
Make checks payable to "Calvary Lutheran Church." Put "NCIS" in memo line.
NOTE: Your child will not be registered until you complete and submit the registration form and payment is received.

Quantity:
Add To Cart

 

Brief Definitions and Possible Signs of Child Abuse

If you are able to drive, you must read these definitions and indicators:

Neglect - Child neglect is defined as omission of the child’s basic needs – physical, environmental, emotional, and nutritional – that are necessary for a child’s physical and emotional well-being.

Possible Signs of Neglect:

  1. Failure to thrive
  2. Inappropriate dress for climate
  3. Stealing of food
  4. Depression
  5. Untreated medical conditions
  6. Poor hygiene

Emotional Abuse – Emotional abuse is abuse in which a person exposes a child to spoken and/or unspoken violence or emotional cruelty. Emotional abuse sends a message to the child of worthlessness, inadequacy, and being not only unloved but undeserving of love and care.

Possible Signs of Emotional Abuse:

  1. Withdrawal behavior
  2. Failure to thrive
  3. Threats of or attempts of suicide
  4. Extreme attempts to seek adult behavior
  5. Extreme passive/aggressive behavior patterns

Physical Abuse  - Physical abuse is abuse in which a person deliberately and intentionally causes bodily harm to a child. Examples may include violent battery with a weapon (knife, belt, strap, or other), burning, shaking, kicking, choking, and any of a wide variety of non-accidental injuries to a child’s body.  

Possible Signs of Physical Abuse:

  1. Hostile and aggressive behavior toward others
  2. Fearfulness of parents and/or other adults
  3. Destructive behavior toward self, others, and property
  4. Inexplicable physical injuries, repetitious injuries

Sexual Abuse – Sexual abuse is abuse involving sexual contact between a child and an adult, or between a young child and a significantly older child. Also included is verbal abuse of a sexual nature and exposing the child to pornography.

Possible Signs of Sexual Abuse:

  1. Unusually advanced sexual knowledge and/or behavior for child’s age and development
  2. Sexually reactive behavior
  3. Clingy behaviors -won’t separate from one adult to another
  4. Run away from home behavior
  5. Physical symptoms, such as headaches, stomachaches, fatigue
  6. Sexually transmitted diseases