OAK HILL BIBLE CHURCH

VACATION BIBLE SCHOOL REGISTRATION FORM

Please complete all information�children must be 4 years old �by August 1st

Child�s Last Name, First Name�� Grade Completed

Birth Date �� as of 6/2003

Last�� First��

ADDRESS � Street:��

Mailing:��

City:�� State:�� Zip:��

PHONE � Home (�� ):�� E-mail address: ��

Parent/Guardian

Mother Name:�� Day Phone:��

Father Name:�� Day Phone:��

Other:�� Day Phone:��

Emergency Contact: (Other than mother or father)

Name �� Phone #:��

Relationship:��

Church Currently Attending:��

ADDITIONAL INFORMATION

(Special needs, allergies, etc.)

��

My signature below releases the Oak Hill Bible Church and/or any of its Vacation Bible School staff from any responsibility for injuries incurred on the premises while attending the Vacation Bible School program.� In the event of an emergency where medical treatment is required, I give my permission to the Oak Hill Bible Church VBS staff to obtain the services of a licensed physician.� The staff will notify my emergency contact or me immediately concerning any such emergency.

Signature:�� Date:��

There is a $10 per child registration fee, with a limit of $30 per family of three or more children.

Please return this SIGNED registration form and fee by June 30, 2003 to

VBS/Oak Hill Bible Church * PO Box 277 * Oxford, MA� 01540

Space is limited!� You will receive confirmation of registration by mail.