Oreland Presbyterian Church

Items with an * are required.
First Name of Child:*
Last Name of Child:*
Address 1:*
Address 2:
City:*
State:*
Zip / Postal Code:*
Telephone #:*
Email:
Father's Name:
Mother's Name:
School Grade Entering:* (in 9/2012)
Birth Date:* (Must be born on or before 9/1/07)
Church Home, if any:
Allergies? (If none, type "none", otherwise please list allergies):*
Alternate Name for Emergency Use:*
Alternate Phone for Emergency Use: *
Is a parent helping at OEPC's VBS?	Yes	No
Parent's Name Helping:

I agree that OEPC may videotape or photograph my child and record his or her voice during their participation in VBS. I agree that OEPC will be able to use them, in whole or in part, whether in original or modified form, in any manner or media, including without limitation, for the purpose of advertising, promoting and publicizing OEPC whether during VBS or thereafter.

Any questions, concerns or further information?

(If you've filled in an email address, expect a registration confirmation shortly.)