OBS_Online VBS Registration - Coventry Church of the Brethren

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VBS Registration

Accepting registrations through July 20.

* Indicates required field

Child One Name *

First

Last

Shirt Size *

Date of Birth *

Grade Completed *

Gender *

Male Female

Child Two Name *

First

Last

Shirt Size *

Date of Birth *

Grade Completed *

Gender *

Male Female

Child Three Name *

First

Last

Shirt Size *

Date of Birth *

Grade Completed *

Gender *

Male Female

Child Four Name *

First

Last

Shirt Size *

Date of Birth *

Grade Completed *

Gender *

Male Female

(Specify child) Allergies/Medical Info *

Parent/Guardian #1 *

First

Last

Parent/Guardian #2 *

First

Last

Consent *

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 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.

Parent/Guardian #1 Address *

Line 1

Line 2

City

State

Zip Code

Country

Parent/Guardian #1 Phone Number *

Parent/Guardian #1 Email *

Parent/Guardian #2 Address (IF DIFFERENT) *

Line 1

Line 2

City

State

Zip Code

Country

Parent/Guardian #2 Phone Number *

Parent/Guardian #2 Email *

Emergency Contact #1 Name *

First

Last

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Emergency Contact #1 Phone Number *

Emergency Contact #1 Relationship to Child *

Emergency Contact #2 Name *

First

Last

Emergency Contact #2 Phone Number *

Emergency Contact #2 Relationship to Child *

Name(s) of those who may pick up your child / children *

Church you regularly attend *

Photo Usage *

I give my permission for my child/children to appear on Coventry Church of the Brethren’s website and/or facebook page. I DO NOT give my permission for my child/children to appear on Coventry Church of the Brethren’s website and/or facebook page.

Submit

Phone: (610) 326-5426
Fax: (610) 326-5469
Email: office@coventrycob.org

CONNECT. GROW. SHARE.

A Christ-centered family of faith practicing
one-another love from generation to generation.

Coventry Church of the Brethren
946 Keen Road
Pottstown, PA 19465

Home
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Donate