Loma Linda Chinese Church VBS Registration
Date: July 8-12, 2019, 6:00-8:30pm (Registration starts at 5:30 on July 8)
Ages: 4-12 (If younger than 4, a parent or guardian MUST be present during the program)
Location: Loma Linda Chinese SDA Church, 25665 Van Leuven St. Loma Linda, CA 92354
Info: email Sammy Young, director: samuelyanhimyoung@gmail.com

ON ARRIVAL, YOU MUST SIGN MEDICAL RELEASE AND PHOTO RELEASE FORMS.

Child's full name *
Your answer
Parent's full name *
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Street Address *
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City *
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State *
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Zip *
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Email *
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Primary Contact *
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Primary Contact Phone *
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Secondary Contact
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Secondary Contact Phone
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Please list any allergies your child has (food, medication, etc.)
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Please list any medical problems, medications your child is currently taking, or other pertinent medical information.
Your answer
Do you have any questions or concerns?
Your answer
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