VBS Student Registration

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2017 DKUMC VBS Digging for Treasure
Dates: 6/19-6/23 (6PM-9PM)
REGISTRATION FEE:
$20 until 6/4
$25 until 6/11
$30 afterwards

Email *

Name of Child *

Address *

Birthdate / Last school grade completed *

Medical concerns/allergies *

Name of parent/primary guardian *

Name(s) of authorized pick-up *

Primary phone # *

Secondary phone #

Emergency contact / phone # *

Church affiliation (optional)

Child T-Shirt Size *

XXL

Other:

I, as the parent and/or legal guardian of the above student give my voluntary consent to his/her participation at Delaware Korean United Methodist Church VBS and all of its activities under their leadership. I agree to remain legally responsible for any personal actions taken by the above named student and release the leaders and pastors of any liability related to any physical or property damage caused to or by the applicant. I am liable for any and all costs that may arise from such incidents. In case of injury or sickness, I authorize any hospital, physician, or chaperone to seek the required medical attention that may be deemed appropriate. *

Yes

Date

YYYY

Parent/guardian signature *

A copy of your responses will be emailed to the address you provided.

Submit

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