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Andrea Antonucci of Ansonia, Fairfield University, Fairfield, CT Casey Russo of Lincoln, IL, Lincoln Christian College, Lincoln, IL Ashley Antonnuci of Ansonia, St. Joseph High School in Trumbull Nicholas DeLaurie of Naugatuck, Naugatuck High School Ashley Franklin of Southbury, Waterbury Arts Magnet School Kyle Ripperger of New Milford, Central Christian Academy in Southington Our Congratulations and best wishes!
PCTC UPDATE Our teens will be attending this year's annual Pennsylvania Teen Convention in Harrisburg, PA. The dates for the 2010 Convention are February 26-28. Plans are to leave Friday morning and return Sunday evening early. If you would like to attend, you must fill in a our Registration/Permission Form and return it to the church office. Your expenses will be a $50 Registration fee and spending money. Transportation and Lodging will be provided by the church.
P.C.T.C. 2010 Registration/Permission
Slip Names of parents or Legal Guardian_____________________________________________________________ Street Address _____________________________________________________________________________ City, State, Zip _____________________________________________________________________________ Home phone______________________ Work_____________________ Cell____________________________ If in the event of an emergency, we cannot be reached at the above
numbers, please call one of the following
people. Name________________________________________ Phone number_________________________________ Name _______________________________________ Phone number________________
Additional Medical Information Insurance Company and Policy # For the above named minor, a legal guardian must fill out the
following: I hereby give permission for the above
named young person to participate in the: I
hereby release Woodland Church of Christ, its staff, and youth sponsors
from responsibility and liability for any injury or illness that the above
named young person, who is under my legal guardianship, may sustain during
the Additionally, I authorize an adult youth sponsor of Woodland Church of Christ to act as an agent for me to consent to any X-ray, examination, medical/dental/surgical diagnosis, treatment/hospital care advised and supervised by a physician/surgeon/dentist licensed to practice under the laws of the state in which services are rendered, either at a doctor's office or at a hospital, in the event that I am not able to make those decisions for myself.
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