VBS REGISTRATION FORM

Green Pastures Presbyterian Church Vacation Bible School 
July 7 (Fri) – July 8 (Sat), 2023 9:30 a.m.– 4:00 p.m.
Fee: $20 per child (includes snack and lunch)

Space is limited, therefore register today!

Theme:  Following Jesus changes the game (Psalm 25:4)

VBS Contact: Ariel Kim (408) 483-8529 or arielekim@gmail.com

Green Pastures Presbyterian Church  1948 The Alameda, San Jose, CA 95126
https://www.greenpastures-church.com/

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Child's Grade (entering fall 2023) *
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Child's Birth Date
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Parent/Guardian Name(s) *
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Parent/Guardian  Email *
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Allergies or Special Needs *
LIABILITY RELEASE :

In consideration of Green Pastures Presbyterian Church (“Church”) allowing the above child(ren) to participate in Vacation Bible School activities, I hereby release, discharge and agree to hold harmless Church, its directors, employees, volunteers and agents from any and all liability, claims or demands for accidental injury, sickness or damage and expenses, of any nature which may be incurred and the above child(ren) while involved in daily Vacation Bible School activities.
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MEDICAL TREATMENT PERMISSION:

I give permission to Church to take whatever emergency measures that are judged necessary for the care and protection of my child while under the supervision of the Church.   

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PHOTO/PICTURE PERMISSION: 

I give my consent to Church to use photo or video images taken of my child(ren) in Church brochures, advertisements for the Church, on the website, in social media, and in other Church publications as they see fit. 
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