2022 Coventry COB VBS "Zoomerang!"

Who: 4 years old through 6th grade (completed 6th grade)
When: Monday, July 25th through Friday, July 29th, 6-8:30pm
Where: Coventry Church of the Brethren (946 Keen Rd. Pottstown, PA 19465)

Child Information

Eligible Children: Age 4 (by July 31, 2022) through 6th grade (completed 6th grade)

List ALL Children Attending: First AND Last Name, Grade Completed, Birthdate (m/d/y) & T-shirt Size

List any allergies/medical information (specify child)

List any other information that would be helpful for us to know about your child/children:

Parent Information

Parent Name

Parent Email

This address will receive a confirmation email

Parent Phone

Parent Address

Second Parent Name

Second Parent Email

Second Parent Phone

Church you attend:

EMERGENCY CONTACT INFORMATION

Please list an emergency contact OTHER THAN PARENTS. We will ALWAYS contact parents first in any circumstance, however, in the event that we cannot connect with a parent, we need another person to contact.

Emergency Contact Name:

Emergency Contact Phone:

Relationship to Child/Children:

PERMISSIONS

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

I, the parent or legal guardian of the above named, allow him/her to attend VBS. 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 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

Description

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2022 Coventry COB VBS "Zoomerang!"

Description

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