Hebrews 6:19 (NLT) – This hope is a strong and trustworthy anchor for our souls. It leads us through the curtain into God’s inner sanctuary

The goal of the 2021 Summer VBS is to provide students from the age of 2 through 12 the Biblical knowledge of who Jesus is and what we are capable of through Him with the usage of dynamic worship, engaging craft workshops, and fun Bible studies.   

MEDICAL RELEASE (Please have parents complete below if you were born after the year 2003)

As parent or guardian of the minor named below, I hereby authorize my child to participate in the VBS program being conducted by Rejoicing Presbyterian Church of Southern California. 

Where: Rejoicing Presbyterian Church of Southern California, 25500 Vermont Ave, Harbor City, CA 90710

Jie Chung JDSN (VBS Coordinator): 323-717-4665; gcem.jie@gmail.com

When: 6:30PM~9:30PM, Friday, August 6, 2021  

10:30AM~5PM, Saturday, August 7, 2021 (Waterslide and bouncer party @ 1PM) 

11AM~12:30PM, Sunday, August 8, 2021        

Fee (costs cover the dates 08/06~08/08/2021): 

$30 for VBS students; 

(for Office use ONLY: Paid: (Y/N); Cash/ Check #

I hereby release and discharge Rejoicing Presbyterian Church of Southern California and their adults, leaders, and young adult volunteers for any damage, losses or injuries to person or property that may be sustained while participating in these activities. 

I, undersigned parent or legal guardian of the minor named below, authorize treatment and/ or hospitalization that is necessary in the case of accident or illness of my child by a licensed medical physician. However, every attempt will be made to reach me by telephone prior to any treatment. 

In the event that I cannot be reached in an emergency, I hereby give my permission to the licensed physician selected by the church leader to hospitalize, to secure proper treatment and/ or order an injection, anesthesia, or surgery for my child as deemed necessary. 

I also realize that even though there will be leaders that will do their best to be vigilant in every situation and activity during the VBS program, that there is a certain amount of risk that my child might get hurt or receive some/ any type of physical harm.

_______________________________    ___________________________________

Print Name of Student                 Signature of Student

_______________________________    ___________________________________

Print Name of Parent/ Guardian          Signature of Parent/ Guardian

Date: ____ / _____ / 2021

Person(s) Authorized to Pick Up Student on Parent/ Guardian’s behalf: 

1.) ___________________________________

2.) ___________________________________

3.) ___________________________________

_________    _______________________       ________________

Date         Age and/or Grade of Student        Male / Female

______________________________________________________________________

Address

______________________________ , CA   __________________

City ZIP

Telephone numbers I can be reached:   1.) ______________________________

2.) _____________________________

3.) _____________________________

Health Information:

Any current health conditions we should be aware of? If yes, please explain. 

___________________________________________________________________

Medications? _________________________________________________________

Allergies? ___________________________________________________________

Health Insurance Company ________________________________________________

Insurance Group # and ID # _______________________________________________

Family Doctor & phone number: ____________________________________

 

***Please Submit The Form At The Bottom To Register***