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FKPC VBS Summer 2023 - Registration Form
Date: 7/5(Wed) - 7/8(Sat)
Time: 9:00AM-1:00PM (Childcare provided until 4pm)
Ages: Preschool - Grade 5
Fee: $10 (Early Bird until 5/14, $15 after)
**Tshirt and Lunch provided!**
Register at "
www.fkpc.org
"
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* Indicates required question
Child’s name (이름)
*
Your answer
T-shirt Size
*
XS (youth)
S (youth)
M (youth)
L (youth)
S (adult)
M (adult)
L (adult)
Child’s age (나이)
*
Your answer
Date of birth (생년월일)
*
MM
/
DD
/
YYYY
Grade Completed
*
Preschool
Kindergarten
First Grade
Second Grade
Third Grade
Fourth Grade
Fifth Grade
Other:
Name of parent(s) (부모님 성함)
*
Your answer
Street address (주소)
*
Your answer
City (address)
*
Your answer
State (address)
*
Your answer
Zip Code (address)
*
Your answer
Parent/Care giver’s Cellphone Number (부모님핸드폰)
*
Your answer
E-mail address (이메일)
*
Your answer
HomeChurch (다니는교회)
*
Your answer
Emergency Health Information
Allergies or other medical conditions (알레지나 다른 병역)
*
Your answer
Emergency contact Name + Relation to Child + Phone number (위급연락 + 아이와관계 + 전화)
*
Your answer
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.
*
YES, I give my consent
NO, I do not give my consent
Parent/Guardian Signature (Print name)
*
Your answer
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