2019 VBS Roar Registration
65-15 164th St. Fresh Meadow NY, 11365
Time: August 12 - August 15 (9 am -12pm) (4 days)
Contact: 718-463-8462
Contact Person: Pastor Frank Huang
Price: $30 (Check Title: QHC)
Ages: 5-12
Name of Child 孩子名字 *
Your answer
Parent Name 父母親名字 *
Your answer
Grade in Sept. 九月的年級 *
Your answer
Address 地址 *
Your answer
Phone 電話 *
Your answer
Allergy 過敏 *
Your answer
T-Shirt Size (Youth Size) *
As a parent/ guardian of a participant in this program, i recognize and acknowledge that there are certain risks of physical injury and i agree to assume the full risk of any injuries, damages or loss which i or my ward my sustain as a result of participating in any and all activities connected, or in any way associated with the activities of this program. 作為家長/監護人,本人明確知道這項活動會有身體損傷的風險,本人願意承擔在參與這項活動中或任何與是項活動有關相連的活動中可能發生的所有風險、損傷、毀壞或損失。 *
Parent Signature 簽名 *
Your answer
Payment 付款 $30 *
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