2022 VBS Registration — Gospel Life Fellowship

Student 1 (NAME, BIRTHDATE, GRADE IN FALL)

Student 2 (NAME, BIRTHDATE, GRADE IN FALL)

Student 3 (NAME, BIRTHDATE, GRADE IN FALL)

Parent/Guardian Name

Phone Number

Address

How did you hear about us?

My Church

Poster Advertisement

Through a Friend

I have attended before

Other

Communication Requests

I would like notifications for future VBS and Victory Night (10/31).

I would like more information about this church

MEDICAL INFORMATION

Use Student Health Information on File (If you check this box you do not need to fill out this section. We will use the information from your Student Registration Form)

Allergies (If more than one child, please write child's name next to allergy)

Does your child have any medical/special needs, including medications currently used?

YES

Health Insurance Company and Policy/Group Number

LIABILITY RELEASE

Signature

By electronically signing below, I, parent or guardian of the above student(s), authorize adult leaders of of Korean Presbyterian Church of Baltimore as agent(s) for the undersigned, to consent to medical care deemed advisable by an accredited physician or surgeon in an approved emergency clinic or hospital if I am not able to be reached. I release from any liability Korean Presbyterian Church of Baltimore, any of its ministers or leaders in the event of an accident during KPCB VBS August 2-6, 2022.

Date

Thank you for registering for KPCB VBS 2021! We will follow up with more details soon.

2022 KPCB VBS