1. 이름: 한글)__________________ 함께 참석하는 형제)__________________
2. 주소: ____________________________________________________________
____________________________________________________________
3. 전화번호: 집)______________________ 핸드폰) _____________________
4. 생년 월일: _________________________ 학년(또는 나이):______________
5. 주일학교에 나갑니까? Y N
나가는 교회 이름:__________________-___________________________
6. 저희가 특별히 알고 주의해야 할 사항들 (예, 음식, 몸이 불편한 점)
________________________________________________________________
________________________________________________________________
7. 비상시 연락 할 가족:
이름:_________________________ 전화: __________________________
8. Youth T-Shirt 크기: ( XS, S, M, L, XL ) * 신청서는 아이당 한부씩 작성해 주십시요.
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2006 KBCA VBS Medical Release Form
This form must be completed and provided to VBS staff on or before the first night of VBS (May 29, 2006).
I _____________________ (parent/legal guardian) hereby consent that the following children:
Child Name: _________________________________
may participate in the Vacation Bible School (VBS) at The Korean Baptist Church of Austin, May 29 – June 1,2006. In case of an
emergency regarding the above mentioned minor (s), I understand that every effort will be made to contact me (parent/guardian).
In the event that I cannot be reached, I hereby authorize emergency medical care for my child while attending VBS, if in the judgment
of the program staff, treatment is required for an injury or illness. I understand the VBS staff will provide first-aid within their capacity to
do so. I hereby give consent to proper medical treatment and hospital care, as well as to procedures deemed necessary by the
attending physician when the need for such treatment is immediate. I also give permission for my injured children to be transported to
the nearest hospital if deemed necessary. I understand that I am responsible for any expenses for medical care or transportation
incurred by my family members or myself. I have registered my emergency contact phone number on the registration form. I have also
registered any allergies or special instructions for my children.
I hereby release and hold harmless The Korean Baptist Church of Austin , its volunteer staff, employees, agents, and directors
from and against any and all actions, losses or claims of any kind of nature, which may arise as a result of an accident or injury
suffered by my children while attending and participating
in this event.
Signature: __________________________ Date: ________________________
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