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First Presbyterian Church of Astoria, Oregon

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2017 Online VBS Registration Page

June 10 is the last day to register on-line. After that, please register on-site.
Please note: check-in/registration will be located at the Astoria First Presbyterian Church.

The cost is $15.00 for one student or $25.00 per family. (no child will be turned away for lack of funds)

All fields with a red asterisk (*) are required. Those fields must be filled in for your application to go through when the Submit button at the bottom of the page is clicked.

Please fill out individual registration forms for each participating child.

* Indicates required field

Student's Name: *

First

Last

Grade entering in the fall: *

VBS is offered to children from ages 3-12. Pre-School age children must be potty trained.

Birth Date: *

Age: *

T-Shirt Size: *

Food Allergies/Health Conditions: *

Parent/Guardian Name *

First

Last

Those of you who have participated before know what a great event this is. We want every child to have a safe, unforgettable adventure. This year, you can really help us make it happen. We are expecting a larger group of participants, so we will need more adults to escort them between activities. If you can spare a day or two to help, please check the box below and we will contact you. Thank you.

Can you (parent) help with VBS? *

Monday Tuesday Wednesday Thursday

Home Phone *

Cell Phone *

Work Phone *

Mailing Address: *

City, State Zip *

Email *

Preferred Method of Contact *

Phone Email Mail

Emergency Contact *

In Case

Relationship to the Child *

Emergency Contact Phone Number *

Permission to Publish Your Child's Photograph? *

Yes No

We take photographs through VBS week to put on this website. In addition, we produce a brochure for the parents to see the various activities that their child has participated and to promote next year's VBS.

Medical Release Statement - Agree? *

Yes No

In case of a medical emergency, I understand every reasonable effort will be made to contact me. In the event that I cannot be reached through reasonable efforts, I hereby give my permission to the physician selected by the program director to secure proper treatment or to hospitalize, to order injections, anesthesia, or surgery for my child. On behalf of the parents/guardians, I further agree that I will not hold the sponsoring churches of the Astoria Community VBS, their agents or employees, responsible for any accident or injury.

Signature of Parent/Guardian *

Electronic signature for Medical Release Statement.

Date of Medical Release Agreement *

Comment *

Submit