Vacation Bible School 2009 by fionan


									CHOONG HYUN MISSION CHURCH Vacation Bible School 2009 - JUNE 25 th to 27th

영아부 Toddler (only Fri 26th & Sat 27th) - $10 per child. 유치부, 유년부, 초등부 K-6 Grade - $15 for 1st child, $10 for 2nd child.

NAME: _____________________ AGE: _________ DATE OF BIRTH: _____________GRADE: ______ DEPARTMENT: ______________ ADDRESS: _________________________________________ ZIP______________ T-SHIRT SIZE: Small / Medium / Large

IN CASE OF EMERGENCY - Contact Person: _______________ Cell: ___________ Dietary restrictions, allergies or other medical conditions: _____________________ ______________________________________________________________________________
I agree to assume full responsibility for the applicant’s actions and consequences during their participation in this program. I hereby release Choong Hyun Mission Church (CHMC) and associated staff from all liability, claims, losses, costs, expenses (including without limitation and attorney fees) or demands resulting from injury, loss, death from the applicant’s participation in Vacation Bible School 2009, June 25 th to 27th, held onsite at CHMC. I have read, understood and accepted the terms and conditions stated herein and acknowledge that this agreement be effective binding upon the applicant hereafter. PARENT’S NAME (print) ____________ Relationship to applicant____________ PARENT’S SIGNATURE____________________________ DATE_______________

For an opportunity to donate! $5 _____ $10 _____ $20 ______ $ 50 _____ $100 ______ other _____

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