FKPC VBS Summer 2024 Registration Form
Date:   6/19(Wed) - 6/22(Sat)    ** 6/22 Sat. - Fun Day!  Huge waterslide & pizza!
Time:   9:00AM-1:00PM      
Ages:   3 year old - Grade 5
Address:   First Korean Presbyterian Church
                  300 Chapel Road, Manchester, CT 06040                   
Fee:    FREE   

** Tshirt and lunch are provided! **
** Childcare is provided until 4pm **
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Child's First and Last Name *
T-Shirt Size *
How old is the child? *
Date of Birth *
Grade Completed *
Does the child need a childcare after VBS? *
When does the child need a childcare?   *
Required
Name of Parent(s) or Guardian(s).   How are you related to the child? *
Street Address *
City (Address) *
State (Address) *
Zip Code (Address) *
Parent/Care Giver’s Cellphone Number:
 *
E-mail address :
 *
Your Home Church
 *
Emergency Health Information
Allergies (to food, pollen, medicine, or other) or other medical conditions (알레지나 다른 병역):
Emergency contact Name + Relation to Child + Phone number (위급연락 + 아이와관계 + 전화):
 *
I give the First Korean Presbyterian Church and its staff permission to care for and administer first-aid in the case of an injury and transport my child to a medical facility if deemed necessary. In the event of an emergency, I will be contacted and in no way hold FKPC or volunteers liable for any injury to my child.
 *
Parent/Guardian Signature (Print name)
 *
Submit
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