SCUBA VBC REGISTRATION

SCUBA is a week-long summer event that helps kids dive into a friendship with God. Kids take a deep dive into an amazing undersea adventure where they'll experience the ever-flowing, never ending love of God. Kids will experience a week full of fun activities, yummy snacks, memorable music, and epic adventures that help them grow their faith!

Daily VBC camp (June 17-21) from 9:00am-12:00pm for children ages 4-11 at Laguna Niguel Presbyterian Church, located at 30071 Ivy Glenn Dr, Laguna Niguel, CA, 926771. Registration is $30, to register, fill out the form below and complete payment in the payment portal or call (949) 249-1218. Scholarships are available upon request.

Don’t miss this opportunity to dive deeper into God’s love and have a splash-tacular time at Scuba VBC! We can’t wait to SEA you there!

Please fill out a Registration form below and submit payment for each camper.
Please reach out to the church office (9492491218, office@lnpc.org) with additional questions or for our available scholarship inquiries.

Scuba VBC 2024 Registration

Childs' First Name:

Childs' Last Name:

Parent/Guardian Full Name:

Parent/Guardian members of LNPC?:

Yes

Grade Entering Fall 2024:

Child's Birthdate

Address:

Apartment, suite, etc.:

City:

State:

Zip/Postal Code:

Home/Cell/Work Phone:

Home Church:

Emergency Contact other than parent:

Emergency Contact relationship to child:

Emergency Contact Phone:

Language(s) Spoken at Home:

Child’s Preferred Language:

Food Allergies:

Special Needs that May Limit Participation in VBC:

Does LNPC have permission to take pictures of your child for church use (e.g. website, newsletter, social media)?

Yes

Friend Request (we will try to accommodate):

Health Issues/Medical Conditions that the VBC Staff should be aware of:

Regular Medications:

Doctor's Name:

Doctor's Phone:

Date of Last Tetanus Shot:

Preferred Hospital:

Insurance Company:

Insurance Phone:

Insurance Group, Policy, or ID Number:

Medical Release
We, the undersigned parents/guardians of the person listed above. a minor, do hereby request that he/she remain under the care and supervision of Laguna Niguel Presbyterian Church Children’s Ministries from June 17-21, 2024.

Should need arise or be perceived, we authorize and consent to any x-ray examination, anesthetic, medical or surgical diagnosis rendered under the general or special supervision of any member of the medical staff and emergency room staff licensed under the provisions of the Medicine Practice Act or a dentist licensed under the provisions of the Dental Practice Act and on the staff of any acute general hospital holding a current license under the laws of the state of California.

It is understood that this authorization is given to provide authority and power to render care which the aforementioned physician in the exercise of his/her best judgement may deem advisable. It is understood that every effort shall be made to contact the undersigned prior to the rendering of treatment, but that any of the above treatments will not be withheld if the undersigned cannot be reached.

We will not hold Laguna Niguel Presbyterian Church, its members, parent supervisors, chaperones, or any affiliated organization liable for medical aid rendered and will reimburse him/her for medical or other expenses incurred in the care of our child.

This authorization is given pursuant to Section 25.8 of the civil code of California and remains effective only for the dates listed above.

Signature of Parent/Legal Guardian

Signature Date:

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