Vacation Bible School Registration Form

Murray Hills Christian Church

Vacation Bible School 2023

Child Registration Form

VBS 2023 Dates: Monday June 26th-Friday June 30th from 9:00am-12:00pm

Location: Murray Hills Christian Church, 15050 SW Weir Rd, Beaverton

Registration Cost*: $30 per child or $25 additional child

*Scholarships available, if the cost is a harship for your family

please contact our church office for information 503-524-5230

Registration fees can be paid in person by cash or check or electronically on page 2.

Institution Name

STUDENT INFORMATION

First Name*

Last Name*

M.I.

Birth Date *

MonthDayYear

Grade completed 2022-23 school year*

Have you previously attended VBS?

YesNo

If yes, what year?

Home Church (if any)

Street Address*

Address Line 2

City*

Postal Code*

Primary Phone Number*

Secondary Phone Number

Siblings Enrolled in VBS 2023

First NameLast Name

*PLEASE COMPLETE ONE REGISTRATION FORM PER CHILD so we have correct age, and allergy information for each child. Thank you!

EMERGENCY CONTACTS
Please list the first and last names and phone numbers off ALL adults who are allowed to pick up this child. The child will only be released to these people.

Primary Guardian*

First NameLast Name

Relationship to child*

Phone Number*

Alternate Guardian #1*

First NameLast Name

Relationship to child*

Phone Number*

Alternate Guardian #2

First NameLast Name

Relationship to child

Phone Number

Medical Information

Please list all allergies -- or type "none" if there are none*

Does your child carry an epi-pen? (please note: if yes, it is the responsibilty of the child's guardian to ensure the child has the epi-pen at every drop off and pick up)*

YesNo

Please list all medical concerns -- or type "none" if there are none*

Additional Information

Please list any additional adults authorized to pick up the child.

VBS photos/videos are taken for promotional purposes related to Murray Hills Christian Church and Vacation Bible School. These pictures appear in various media outlets such as our newsletter and our Facebook page and Church website. Do you allow your child to be included in these photos/videos?*

YesNo

Murray Hills Christian Church

Vacation Bible School 2023

Child Registration Form

Credit Card