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2009 VBS ENROLLMENT FORM REGISTRATION INFORMATION: Here’s how it works. Application must be filled out completely, including signature, and accompanied with full payment. Due to the limited amount of
children that we can facilitate, only those applications that are paid
in full by Please tear and keep the registration information part of the application for your record COST: Includes Souvenirs/ Student Class Materials/ Various Art Projects/7 meals/ Snacks/ Etc. Before July 26, 2009 ………..$20 After July 26, 2009 …………$25 Payments must be made in full by the above dates to qualify for the above price. If paid by check, write checks payable to: First Burmese Baptist Church Please write your children’s name at the bottom of the check Contact persons are: Shirley Choo Tel: 650-238-7830 Elizabeth Makha Tel: 650-794-0729 HOW TO CONTACT YOUR CHILD DURING VBS: First Burmese Baptist Church Tel: 415-751-3834 EMERGENCY: Rev. Dr. Latt Yishey; Tel: 510-754-9275 Note: Please have your child bring some
offerings as we will be collecting the offering during the sessions |
==================================================================================== CHILD MEDICAL & LIABILITY RELEASE PERSONAL INFORMATION: Child’s Name:
______________________________Tel: ________________________ (Last) (First) (M)
Address:_____________________________________City:__________Zip: ________ Gender:_______; Age:________; Grade
completed: ______ Parent’s/Legal Guardian’s
Name:___________________________________________ TEL: (day)_______________; (night)
______________; (emergency)______________ MEDICAL INFORMATION: Does Child Have: (check any that apply)
□Heart Trouble
□
Diabetes
□
Lung Trouble
□
Asthma
□
Skin Problems
□ Sinus
Infection Date of last Tetanus:__________________;
Allergic to ________________________ Medication
Allergies:___________________________________________________ List allergies and medications taken for
control: ______________________________ List all medication that child may be
taking: _________________________________ Dosage:______________________; Pharmacist
Phone #_______________________ *Please make sure all Meds are turned in
to designated personnel upon arrival. All medication child is presently taking
(including over the counter) must be in original bottle pharmacy
indicating dosage, intervals Emergency Contact Person/Tel#:
________________________________________ List any activities for health reasons
your child cannot be involved in:
_____________________________________________________________________ As Parent/Guardian, I hereby authorize
and request a hospital emergency staffed physician to administer any
procedure which in Parent / Guardian's Signature:
_________________________________________
and
child’s name.
NOTE: PLEASE
INSPECT CHILD(REN) FOR HEAD LICE OR NITS PRIOR TO VBS. NO CHILD CAN BE
PERMITTED TO REMAIN AT VBS IF THESE ARE PRESENT
their judgment may be necessary. I also give permission
to the First Aid Person to release pre-prescribed medication and
non-prescribed medication such as aspirin.
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==================================================================================== 2009 VBS PARTICIPATION CONSENT FORM
□I authorize my child(ren)
_________________________________ to attend and participate all sessions
of the VBS
□In addition he / she
will sleep over at FBBC San Francisco, on Thursday, July 30, 2009 and/or
Friday, July 31, 2009.
□My child(ren) will
abide by the rule and regulations of the VBS program. Parent’s Signature: _____________________________ Date: _____________________________ |