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Vacation Bible School Registration 2017
Event Timing: July 17-21, 2017
Event Address: 6901 Wooster Pike Medina, OH 44256
Contact us at (330) 722-7683 www.MedinaNazarene.org
Email address
Child's Name
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Child's Date of Birth
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Select the grade your child most recently completed.
Parent's/Guardian's Name
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Family's Address (street, city, state, zip)
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Emergency Contact Phone Number
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Parent/Guardian Email Address
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Allergies or Special Needs (or anything else) we should know about your child? (If none, please type "none" in the text box.)
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Who, if not you as listed above, will be picking the child up from VBS each night? (If it will just be you, please type "none" in the text box.)
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A copy of your responses will be emailed to the address you provided.
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