Vacation Bible Adventure-Noah Parent / Guardian Name First Last Address Street Address Address Line 2 City PA ZIP / Postal Code PhoneEmail 1st. Child's Name First Last Age and Date of Birth Separate tags with commas 2nd. Child's Name First Last Age and Date of Birth Separate tags with commas 3rd. Child's Name First Last Age and Date of Birth Separate tags with commas 4th. Child's Name First Last Age and Date of Birth Separate tags with commas Allergies? Yes / No Please SpecifyName of Parent(s), If AttendingEmergency Contact / Other Authorized Adult for Pick-Up First Last PhonePlease Agree I will pick up my children listed above at the close of each evening at 8:30pm. I understand an adult will not be able to drop my children off at the end of the session. I authorize that photos taken of my child during VBS may be used for promotion of Bethany Baptist Church.