2024 VBS Registration - Hometown Nazareth
** Please make $40.00 payment through zelle to Giving-Zelle@efcla.org and add message "2024 VBS" and "Your Child's Name" prior to fill up the registration form or your registration form will be discarded.

Event Date & Time: June 10th ~ 14th, 2024 06:00PM ~ 08:40PM
Event Location:       Evangelical Formosan Church of Los Angeles
                                  9537 Telstar Ave. #101
                                  El Monte, CA 91731
Contact us at:         (626) 450-7676 x16 or rkuo@efcla.org (Ruth Kuo, CC Director)

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Did you pay the $40 registration fee?
 *
** Please make $40.00 Payment through zelle to Giving-Zelle@efcla.org and add message "2024 VBS" and "Your Child's Name" prior to fill up the registration form or your registration form will be discarded.
Required
Participant Full Name *
Gender *
Current Grade *
Date of Birth *
MM
/
DD
/
YYYY
Age *
Address *
Parents Full Name *
Please input the name you are normally called
Relationship *
Cell Phone Number *
Please use the example format 123-456-7890
Email *
Emergency Release *
As parent/guardian, I authorize treatment by a qualified and licensed medical
doctor for the child name above, in the event of a medical emergency which in the
opinion of the medical doctor may endanger the life of the child, cause
disfigurement, physical impairment, or undue discomfort if delayed. This authority
is granted only after reasonable effort has been made to reach me.
Required
Photographs and Videos *
Do you authorize EFCLA – CC to take photographs / videos of child during child’s enrollment in the program. All the photographs/ videos will be took and used only in this VBS activities and for volunteer training purpose and/or EFCLA – CC promotional purpose.
Do you want to add 2nd ER Contact / Medical Info? *
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