SSP 2019 Registration
Dear Parents,

At Roar VBS, kids discover that even though life gets wild, God is good. Roar is filled
with incredible Bible-learning experiences kids see, hear, touch, and even taste!
Sciency-Fun Gizmos™, team-building games, cool Bible songs, and tasty treats
are just a few of the standout activities that help faith flow into real life.

When: 7/20, 7/27, 8/3, 8/10, 8/17
Time: 9:00 AM-12:00 PM
Where: CPC 133-14 41 Avenue, Flushing
Ages: Children entering Kindergarten (born in 2014)- entering 6th grade (born in 2008)
Cost: $25- single child; $30- family

Child's Name 姓名
Your answer
Birthdate 生日
MM
/
DD
/
YYYY
Address 地址
Your answer
Grade in September; 9月份开学时候的年级
Age 年龄
Your answer
T-Shirt Size (youth) T恤的尺寸,圈一个
Parent/Guardian First & Last Name 父母或监护人姓名
Your answer
Cell Phone 手机
Your answer
Work Phone 工作电话
Your answer
Email Address/ WeChat ID
Your answer
Church Currently Attending (if any) 目前参加的教会名字(如果有)
Your answer
Does your child have siblings attending SSP? 您的孩子有没有兄弟姐妹参加我们的这个周六活动?请圈一个答案。
If Yes, please list first and last names (PLEASE REGISTER EACH CHILD SEPARATELY. This question just helps us to make family connections.) 如果有,请写下兄弟姐妹的名字 (但是报名表还是要一个孩子填一份)
Your answer
Dismissal/ Emergency Contact Name & Phone Number #1 接 送孩子的人和紧急联络人 ( 姓名 & 电话号码)
Your answer
Dismissal/ Emergency Contact Name & Phone Number #2 接 送孩子的人和紧急联络人 ( 姓名 & 电话号码)
Your answer
Does your child have an IEP or special needs? Describe. 请列出所有的健康状况和其他特别的需要(包括IEPs)
List all food allergies.请列出所有过敏情况,食物禁忌
Your answer
Current Medications正在服用的药物:
Your answer
Health Insurance Company保险公司名字
Your answer
Physician Name and Telephone Number 家庭医生名字和电话号码
Your answer
As the parent or legal guardian, I consent that my child/children can participate in the Summer Saturdays Program at King’s Cross Church from . I represent that my child is physically fit and can safely participate in these activities.If, in the event of accidental illness or injury, I authorize adult leaders of this ministry to consent for medical treatment for my child and to exercise their reasonable judgment as to appropriate medical care. I also agree to pay all costs and expenses incurred for such services. I understand that in such an event, I will be contacted as soon as possible. Adult leaders of this ministry also have my permission to sign any waiver of liability which may be required. I agree to hold harmless and blameless, the leadership of King’s Cross Church (including members of ministry teams and any additional adults participating in or providing assistance to the activity) from any injury or illness resulting from participation in this activity. I waive all rights to any civil action against the above mentioned parties.Photo & Video Release Policy:From time to time King’s Cross Church takes photographs & videos of children and/or their work for possible use in publications (print & e-mail), exhibitions, website, multimedia presentations, and development purposes. No compensation is provided to individuals who appear in the photographs or videos or for any work used. By signing below, I agree with the Photo & Video Release Policy.The authorization for consent will be in effect from the date of signature until . 我(父母/监护人姓名)同意并支持我的孩子(孩子姓名)参加君王十架教会组织的2019夏季活动,活动日期是2019年7月20日至8月17日。我证明我的孩子身体健康,可以参加此活动。在活动期间,如发生任何意外,我同意不在法律、金钱上追究君王十架教会King’s Cross Church的任何责任或者任何赔偿,我会负责孩子的所有医疗费用。我允许君王十架教会把我孩子的照片用在宣传君王十架教会的活动、筹款、或者任何相关活动上。不管出现任何情况,君王十架教会全部免责。我特此准许King’s Cross Church采访上述的学生丶引用该学生说的话、并给该学生摄影丶录影或录像。另外,我也准许King’s Cross Church出于非牟利的目的编辑丶使用及重复使用以上所述材料,包括:制成印刷品、在互联网上使用以及其他所有媒体形式使用。此外,我谨此豁免King’s Cross Church及其代理人和工作人员承担任何与上述情况相关的索赔丶要求和责任。此活动协议书自签名之日起开始生效,直到活动结束之日2019年8月17日。
SSP is $25 for the first child and $30 for a family with 2 or more children. I understand that registration is not complete until payment has been made.
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