VBS 2023 Registration for Participation

July 24-28 from 9 AM to Noon | Please fill out this form and click submit.

Dear KOG Friends and Family,


This Registration Form is for children preschool age (no longer in diapers or pullups) to 6th grade in the fall of 2023.

Fill out one form per family if all family information is the same and click submit. Please make note that our registration is non-refundable.


The week before VBS you will receive an email with more information of dates and times to all of our events leading up to VBS, including the week of VBS.


Please don't hesitate to reach out with any questions or concerns! 


Let's Grow in Faith, Have Fun and Make a Change Together!


Amanda Pulos 
Director of Youth and Children's Ministry
kogkids@gmail.com
(714)604-3373

If you are 7th grade through high school or even an adult there is a place for you at VBS too! CLICK HERE FOR VOLUNTEER REGISTRATON!

Participant #1

 
 
 
Participant #2

 
 
 
Participant #3

 
 
 
Family Information

Please select one option.
 
 
 
Parent or Guardian's Contact Information

 
 
 
 
 
In the event of an emergency, in which I am not available, please notify:

 
 
Health Information- Please check any that apply and please describe and/or date appropriately:

Please select all that apply.
 
 
 
 
 
 
 
Please select all that apply.
 
Child's Health and Accident Insurance Information

 
 
MEDICAL AUTHORIZATION, RELEASE OF LIABILITY AND PERMISSION FORM (For ALL Youth Under The Age Of 18)

MEDICAL RELEASE STATEMENT AND WAIVER


I hereby authorize King of Glory Lutheran Church, into whose care Minor has been entrusted, to consent to medical or dental treatment or care for Minor under Section 6910 of the California Family Code.  The authority granted by this authorization includes the authority to consent to any x-ray examination, anesthetic, medical or surgical diagnosis or treatment, or hospital care under the general or special supervision and upon the advice of or to rendered by a physician or surgeon licensed under the Medical Practice Act and to any x-ray examination, anesthetic, medical or surgical diagnosis or treatment or hospital care by a dentist licensed under the Dental Practice Act.  It is understood that this authorization is given in advance of any specific diagnosis or treatment being required, and is given to provide authority and power to render care which the aforementioned physician, in his or her best judgment may deem advisable.




I further authorize King of Glory Lutheran Church to receive physical custody of Minor under Section 1283 (a) of the California Health and Safety Code upon completion of any treatment, and I specifically instruct any treating health facility to surrender the physical custody of Minor to King of Glory Lutheran Church of Fountain Valley.   




RELEASE OF LIABILITY:


I understand the nature of the events and do hereby release, acquit, and forever discharge, on behalf of myself and Minor, King of Glory Lutheran Church, its sponsors, agents, servants, successors, heirs, executors, and administrators, from any and all claims, actions (or cause of action), or expenses whatsoever, which the undersigned now has or may hereafter accrue on account of or in any way growing out of any known and unknown, foreseen and unforeseen bodily injuries and property damage and the consequences thereof resulting or to result from any accident, casualty or event which has or may occur during activities sponsored by or under the auspices of said King of Glory Lutheran Church.




The authorization is given pursuant to Section 25.8 of the Civil Code of California and remains effective until revoked.


 
PERMISSION AND AUTHORIZATION TO CONSENT TO TREAT A MINOR:  I, ____________________________________am the parent, legal guardian, or the caregiver who is a relative of, and who, under Section 6550 under the California Family Code, may authorize medical and dental care for_____________________________, (Minor's name) I give permission for Minor to take part in any of the events held with King of Glory Lutheran Church.
 
 
 
 
 
 
Photo Consent

Photographs may be used for the following items:


KOG page, church marketing materials such as Fountain Valley Living or other local magazines, brochures, flyers, church newsletters, and/or other items to help promote KOG Church and Preschool.

The child's name will never be identified.

Please select one option.
Please select all that apply.
 
 
Registration Payments: On or Before July 25th $35 per child OR After July 27th $55 per child No refunds

 
 
Please select all that apply.
 
 
 
 
 
 

Description

July 24-28 from 9 AM to Noon
Please fill out this form and click submit.