Registration Form

Registration Form REGISTRATION FORM

Name: ______________________________________________________________

Sex: M ____ F ____ Date of Birth ____________________________________

Address: _____________________________________________________________

Phone #: __________________

Name of Local Church: ________________________________________________

Pastor: ____________________________________________________________

Level of Education (check one): High School: 8___ 9___10___11___12___

College: Year 1___ 2___ 3___4___

Professionals ______

Occupation: __________________________________________

How long have you been in the U.S? __________________ years.

IMPORTANT!!! MUST BE SIGNED

In consideration for being accepted to participate in Vietnamese Christian Youth Fellowship (VCYF) Camp, and activities associated with its program and location, I am voluntarily responsible for my actions, and release VCYF from loss, injury or damage to myself or my property; provided that nothing contained herein shall excuse VCYF from responsibility to act within reasonable care for the health and safety of myself or my property. Should any dispute or controversy arise, I agree to seek resolution according to Biblical principle.

Signature: __________________________________

Date: ________________

If you are under the age of 18, consent of a parent or legal guardian is required.

I, the parent or guardian of the above named applicant, give my voluntary consent and agreement to the above release. Furthermore, I authorize health professionals retained by VCYF to use their best judgment and administering treatment for minor illness and/or first aid as they deem appropriate.

Parent/legal guardian's signature _______________________________________

Date _____________ Phone #: __________________________