VBS Child Registration

Items with an * are required.  
First Name of Child:*
Last Name of Child:*
Gender:*
Male
Female
Address 1:*
Address 2:
City:*
State:*
Zip / Postal Code:*
Telephone #:*
Email:
Father's Name:
Mother's Name:
School Grade Entering:*
(in 9/2019)

Birth Date:* (mm/dd/yyyy)

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.          Agree      I Do Not Agree

 

Any questions, concerns or special requests?

(Confirmation emails will be sent beginning April 1, 2019. Each registration will receive a confirmation email. If you do not receive a response, please contact the VBS team using the  VBS Question Form.)