Vacation Bible Adventure

Sunday, July 14 through Thursday, 18, 2024

6:00 – 8:30 pm

For children entering 1st – 6th grades

Music, Stories, and lots of fun activities! (Don’t miss the Moonbounce Opening Night!)

Students enjoy FREE DINNER at 6:00 pm

Please pre-register below. Or, email Woodlyn@RCN.com or call us at 610-833-5577.

VBA Registration

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First and Last Name for each child listed below

Child's First/Last Name *

Date of Birth *

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Grade *

Allergies/Medical Conditions

Add another child?NoNoYes

Child's First/Last Name *

Date of Birth *

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Grade *

Allergies/Medical Conditions

Add another child?NoNoYes

Child's First/Last Name *

Date of Birth *

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Grade *

Allergies/Medical Conditions

Add another child?NoNoYes

Child's First/Last Name *

Date of Birth *

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Grade *

Allergies/Medical Conditions

Add another child?NoNoYes

Child's First/Last Name *

Date of Birth *

MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920

Grade *

Allergies/Medical Conditions

Home Address *

Address Line 1

City

— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Phone *

In Case of Emergency, Notify:

First/Last Name #1 *

Relationship to Children *

Home Phone

Cell Phone

First/Last Name #2 *

Relationship to Children *

Home Phone

Cell Phone

I would like to authorize the following person(s) to pick up my child from this activity: *

Is there any other information you would like us to know in order to serve your child better?

How did you hear about our Vacation Bible Adventure?

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