MPC SDC 2024 REGISTRATION FORM
Please complete a registration form for each child thoroughly.
(한 자녀당 등록 양식을 작성해주세요)
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Email *
Email address
(이메일 주소)
 *
Child's First Name *
(자녀의 이름을 작성해주세요)
Child's Last Name *
Father/Legal Guardian's Name (아버님/보호자 이름) *
Father/Legal Guardian's Contact # (아버님/보호자 전화번호) *
Mother/Legal Guardian's Name (어머님/보호자 이름) *
Mother/Legal Guardian's Contact # (어머님/보호자 전화번호) *
Child's Date of Birth (MM/DD/YYYY) (자녀의 생년월일) *
MM
/
DD
/
YYYY
Child's Grade going in September 2024 (자녀가 2024 9월에 학교 들어갈 학년) *
Required
Home Address (집주소) *
Emergency Contact- Name (학생 긴급상황시 연락처분 이름) *
EMERGENCY CONTACT PERSON IF OTHER THAN PARENT/LEGAL GUARDIAN #1 (부모/보호자 말고 다른사람을 써주세요)
Contact # (긴급상황시 연락처 번호) *
EMERGENCY CONTACT PERSON IF OTHER THAN PARENT/LEGAL GUARDIAN #1 (부모/보호자 말고 다른사람을 써주세요)
Relationship to the Child (아이와 윗분에 관계) *
EMERGENCY CONTACT PERSON IF OTHER THAN PARENT/LEGAL GUARDIAN #1 (부모/보호자 말고 다른사람을 써주세요)
Is this person allowed to pick-up the child? (윗분이 아이를 픽업해도 되나요?) *
EMERGENCY CONTACT PERSON IF OTHER THAN PARENT/LEGAL GUARDIAN #1 (부모/보호자 말고 다른사람을 써주세요)
Food allergies, health concerns, special conditions, medications? (알러지, 건강관심도, 약먹는등 해당되는게있으면 모두 작성해주세요) *
If yes, please list them
Weeks of Attending Day Camp (캠프에 참여할 기간) *
Required
Extended Care (Optional; Please check all that apply) (연장으로 돌보는 시간. 필요하신분들만 해당되는 항목을 표시해 주세요) *
Required
Physician's Name (의사 이름) *
HEALTH PROVIDER INFORMATION (의료보험 정보)
Contact # (병원 전화번호) *
HEALTH PROVIDER INFORMATION (의료보험 정보)
Health Care Insurance Company (의료보험 이름) *
HEALTH PROVIDER INFORMATION (의료보험 정보)
Health Care Insurance Policy # (보험카드 번호) *
HEALTH PROVIDER INFORMATION (의료보험 정보)
I also legally authorize MPC Summer Day Camp to take/use photographs and videos of my child for use in future promotional materials. (나는 몽고메리 여름캠프에서 찍는 사진과 비디오를 나중에 홍보용으로 쓸수있게 허락한다.) *
Do you or your child/children currently attend Montgomery Presbyterian Church for Sunday worship? (현재 내 자녀들은 몽고메리교회를 다닌다) *
Required
As a parent/legal guardians(s), I/we give consent to MPC Summer Day Camp staff to provide medical or dental care for my child (named above) in case of an accident. I agree NOT to hold MPC Summer Day Camp and its leadership and staff (and Montgomery Presbyterian Church, and their Board of Trustees, Session or Staff) liable for any injury, death and/or accident that may occur while my child is on the premises and/or at one of its functions, such as trips beyond the day camp facility. Further, I/we agree to assume all financial responsibility for all necessary medical and dental care and all emergency transportation services. I/we also understand that all attempts will be made to contact me/us. (나는 자녀의 부모로서 몽고메리 여름캠프 직원에게 만약을 대비해 자녀들의 의료보험 혹은 치과보험을 제공하겠다. 나는 내 자녀가 캠프안에서 다치거나 혹은 어떠한일이있어도 캠프 직원들, 선생님들한테 책임을 가하지 않겠다. 긴급상항시 캠프 직원들은 나한테 연락할것을 난 동의합니다.) *
By entering my name, I am electronically signing this form, thus giving legal consent. (Please write the following -in separate lines- in the text box: Father/Legal Guardian's Name, Mother/Legal Guadian's Name, Date) (아버님/보호자 이름, 어머님/보호자 이름, 날짜를 써주시면 모든걸 동의하시게됩니다)
A copy of your responses will be emailed to the address you provided.
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