2025 KCPC Vacation Bible School (VBS) Nursery (영아부) Registration

• Date: 6/23 (Mon) ~ 6/27 (Fri)
• Time: 9:30 am – 12:30 pm
• For: Age 3 (10/01/2021 ~ 09/30/2022, must be potty trained)
• Limit: 50 (정원 : 50명)
• Contact: 김주영 전도사 juyoung.kim@kcpc.org

Child's Information

English Name

Korean Name

Date of Birth

Gender

Grade (Current Grade)

영아부 (10/01/2021 ~ 09/30/2022)

Preference/ Spoken Language

English Korean Both

T-Shirt Size

Youth XS (3 Years)

Health Concerns

N/A Allergies ADD/ADHD Developmental disability (Autism, Down Syndrome, and etc. ) Diabetes Prescribed medication Other

Any restrictions or additional comments

Parent/Guardian's Information

Parent/Guardian's Name

This address will receive a confirmation email

Phone (ex. xxx-xxx-xxxx)

Address

Emergency Contact

Name

Phone (ex. xxx-xxx-xxxx)

Relationship to child

Other Information

Does your child attend church?

Yes No

If yes, current church name

How did you hear about KCPC VBS?

PARENTAL CONSENT - Medical Release Waiver

I UNDERSTAND AND AGREE TO THE FOLLOWING:

- MEDICAL TREATMENT: As a guardian of the above named student, I hereby release and agree to hold harmless Korean Central Presbyterian Church and designated leaders from all liability for damage, illness or injury. In case of emergency, I give permission to have my child transported to the Emergency Room of the nearest hospital, and the medical staff has my authorization to provide medical treatment for my child.

- PHOTO CONSENT: Registering my child for KCPC VBS implies consent to take photographs and videotaping that include my child for newsletters and promotional media purposes. Children will not be identified by name in photo captions.

- ILLNESS POLICY: Please keep your child at home or expect to pick up your child from VBS for the following conditions: fever (100° or more), headache, vomiting, diarrhea, severe itching, pain, sore throat, infected skin or eyes or undiagnosed rash, difficulty in breathing, persistent cough, phlegm and lice.

- MISBEHAVIOR POLICY: The VBS team will contact you to pick up your child when your child engages in behavior that is disruptive to the orderly operations of VBS.

LIABILITY WAIVER: I acknowledge that I will not seek to have KCPC Vacation Bible School (VBS) held liable in the event that any accident, injury, loss of property or any other circumstance or incident occurs during or as a result of my child participation in VBS. This release of liability includes accident, injury, loss, or damages to the student, as well as, to other individuals or property which may result from the student's participation in VBS or VBS related activities. I hereby release and agree to hold harmless KCPC VBS, its officials, teachers, teaching assistance, staff and employees, from any claims arising out of my child participation in VBS. I have read and understand and accept all of the statements recited above and accept full responsibility as described.

I have read and agree to the above statement.

Payment

The Registration processing will NOT be completed without full payment.

- VBS Fee : $10 (per child), No sibling discount, Non-Refundable

Thank you for registrering your child at KCPC Vacation Bible School (VBS) and we look forward to seeing your child soon!

Payment $10

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

2025 KCPC Vacation Bible School (VBS) Nursery (영아부) Registration - Volunteer/ PK

Description

2025 KCPC Vacation Bible School (VBS) Nursery (영아부) Registration - Volunteer/ PK

Description

Please Fix the Following