This 3 sentence summary provides the key details from the VBS registration form document: The document is a registration form for a church's Vacation Bible School that collects information such as the child's name, birthdate, grade, parent/guardian contact details, medical information, and an emergency medical release signature in order to register the child for VBS classes. The form notes that photocopies are accepted and there is a $8 per child or $24 family maximum registration fee.

1. One form per child. Photocopies accepted. Reg. Fee: $8 child/$24 family max.
Name_____________________________________________ M/F
(First) (Last)
Birthdate: ______/______/______ Age: _______ Grade In Fall: _______
(NOTE: Placement is made according to school grade, friends/guests of different grade levels will not be
placed in the same class).
Special Request to be with Friends/Teacher (we try to honor requests, but no guarantees):
____________________________________________________________________
Parent/Guardian: [ Ms. / Mrs. / Mr. ] ______________________________________
(Circle) (First) (Last)
Home Phone: ______________________ Alt. Phone: ________________________
Address: ____________________________________ City: ___________________
State: ______ Zip: __________
Alternate Contact: ____________________ Phone: ________________________
Church You Attend: ____________________ Invited by: ___________________
Snack/Food Allergies: ________________________________________________
Medical allergies: ____________________________________________________
Medical problems or other pertinent information: __________________________
____________________________________________________________________
Medications being taken: _____________________________________________
(NOTE: if medication must be administered during VBS hours, it must be checked into the office at check-
in time to be dispensed by office staff).
EMERGENCY MEDICAL RELEASE: I give permission for my son/daughter
to receive any medical attention that may be deemed necessary.
___________________________________ [SIGNATURE REQUIRED]
Insurance Co _________________________ Policy # _______________________
Oregon City Evangelical Church ~ 1024 Linn Avenue / PO Box 10 ~ Oregon City, OR 97045
(503)656-8582
(Registrar Use Only) Pd Class