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MGC | Школа русского языка | Регистрация учащихся 2024-25
Мы рады в скором времени начать обучение в школе украинского и русского языка на 2024-2025 год. Пожалуйста, заполните эту форму для каждого учащего русскоий язык. Божьих благословений вам и вашей семье!

Первое занятие состоится 13 сентября в пятницу в 7 часов вечера.

We are excited to start studies Ukrainian and Russian language school for the 2024-2025 year soon. Please fill out this form for each  Russian language school student. God bless you and your family! 

The first class will be held on September 13 on Friday at 7 p.m.

Missionary Gospel Church
4148 San Juan Ave, Fair Oaks, CA 95628
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Email *
Имя и фамилия  ученика
(Student's First and Last Name)
 *
Дата рождения ученика  
(Student's Date of Birth)
 *
MM
/
DD
/
YYYY
Возраст ученика 
(Age)
 *
В каком классе будет учится? 
(What class will your child study in?)
 *
Адресa 
(Address)
 *
Фамилия и имя отца 
(Father's First  and Last Name)
 *
Фамилия и имя матери
(Mother's First and Last Name)
 *
Телефон отца 
(Father's Phone Number)
 *
Телефон матери 
(Mother's Phone Number)
 *
Какой класс школы родного языка закончил/закончила? Когда и где? 
(What class of Ukrainian language school did he/she graduate from? When and where?)
 *
В случае медицинской необходимости звонить (имя и номер телефону) 
(In case of medical necessity, call (Name and Phone Number)
 *
Брат или сестра учатся в этой школе ?  Какой класс? (Is a brother or sister enrolled in this school? What class?)
 *
Health insurance plan
 *
Policy# *
Group name
 *
Primay doctor
 *
Phone number of the doctor
 *
In case of emergency (check one):
 *
Parents name(electronic signature)
 *
Important information 

I understand that I will be notified in cașe of medical emergency. However,
in the event parents/doctor could not be reached I authorize the following:
                                               INSURANCE RELEASE
I realize the church insurance begins where the individual health and accident
policy terminates. It is only valid when all other insurance has been extended to its
limits.
                                               GENERAL RELEASE
The undersigned realizes that the participant may incur personal injury or bodily
damage while participating in such activities, and acknowledge that the church, it's
officers, directors, employees, or any other parties volunteering on behalf of the
church, shall be held harmless from all actions, claims, costs, expenses or damages
of any kind, growing out of or related to any activities of the church. The
undersigned further acknowledge this is a full and complete release for all injuries and damages which the participant may sustain as a result of participating in any
activity.
I being the legal guardian give my permission for him/her to participate in church sponsored activities.
Date  *
MM
/
DD
/
YYYY
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