FKPC VBS Summer 2022 - Registration Form
Date: 6/22(Wed.) - 6/25(Sat.)
Time: 9:00AM-1:00PM
Ages: Preschool - Grade 5
Fee:  $10 (Early Bird 4/30, after $15)
          *New friends are Free!*
**Tshirt and Lunch provided!**

Register at "www.fkpc.org"
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Child’s name (이름) *
T-shirt Size *
Child’s age (나이) *
Date of birth (생년월일) *
MM
/
DD
/
YYYY
Grade Completed *
Name of parent(s) (부모님 성함) *
Street address (주소) *
City (address) *
State (address) *
Zip Code (address) *
Parent/Care giver’s Cellphone Number(부모님핸드폰) *
E-mail address (이메일) *
HomeChurch (다니는교회) *
Emergency Health Information
Allergies or other medical conditions (알레지나 다른 병역) *
Emergency contact Name + Relation to Child + Phone number (위급연락 + 아이와관계 + 전화) *
I give the First Korean Presbyterian Church and its staff permission to care for and administer first-aid in the case of an injury and transport my child to a medical facility if deemed necessary. In the event of an emergency, I will be contacted and in no way hold FKPC or volunteers liable for any injury to my child. *
Parent/Guardian Signature (Print name) *
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