Venture Wednesday 2023-2024

Who: 4 years old through 6th grade
When:Wednesdays beginning October 4, 5-7pm
Where: Coventry Church of the Brethren (946 Keen Rd. Pottstown, PA 19465)

PARENT INFORMATION

Parent Name:

Email:

This address will receive a confirmation email

Phone:

Address:

Additional Parent Name:

Additional Parent Phone:

Church Regularly Attend if any:

Are you interested in attending a Bible study 5-6 p.m. on Venture Wednesday nights? Yes Sometimes No

CHILD INFORMATION

Eligible Children: Pre-K (4 years old) through 6th grade

List Children Attending - Full Name, Birthdate, Grade:

List any allergies/medical information (specify child):

EMERGENCY CONTACT INFORMATION - Other than parent

If there is an emergency, we will first attempt to contact parents. If for some reason, we cannot get a parent, we will then call the emergency contact.

Emergency Contact:

Relationship to Child/Children:

Emergency Contact Phone:

Name & Phone # of anyone OTHER THAN PARENTS who have permission to pick up your child:

PERMISSIONS

I, the parent or legal guardian of the above named, allow him/her to attend Venture Wednesday. I recognize the risk involved in activities and will not hold the Coventry COB, its staff or volunteers, responsible for any personal injury that might occur to my child while participating in this program. I authorize a staff member or volunteer from the church to seek and obtain such emergency or medical services for my child as deemed necessary at the time.

I Agree I Disagree (*disagreeing to this statement will not allow your child/children to attend Coventry Church of the Brethren's Venture Wednesday Program)

I give my permission for my child/children to appear on Coventry Church of the Brethren's website, Facebook page and/or other promotions.

I Agree I Do Not Agree

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Venture Wednesday 2023-2024

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