West Union & Wellman Mennonite 2019 Bible School Registration
West Union and Wellman Mennonite are joining together for Bible School this summer. We would love to have your child attend. Please fill out the following form to register your child(ren.)

June 10-14, 2019 at West Union Mennonite Church, 3253 305th St, Parnell, IA
8:30 a.m. - 12:00 p.m. Lunch is provided.
Age 4 - 8th Grade

Parent/Caregiver First & Last Names *
Your answer
Parent/Caregiver Email Address *
Your answer
Primary Phone Number *
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Mailing Address *
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Name and Phone Number of Emergency Contact (other than parent) *
Your answer
Child 1
Name *
Your answer
Current Grade *
Birthdate *
MM
/
DD
/
YYYY
Medical Conditions/Dietary Restrictions/Allergies
Your answer
Child 2
Name
Your answer
Current Grade
Birthdate
MM
/
DD
/
YYYY
Medical Conditions/Dietary Restrictions/Allergies
Your answer
Child 3
Name
Your answer
Current Grade
Birthdate
MM
/
DD
/
YYYY
Medical Conditions/Dietary Restrictions/Allergies
Your answer
Child 4
Name
Your answer
Current Grade
Birthdate
MM
/
DD
/
YYYY
Medical Conditions/Dietary Restrictions/Allergies
Your answer
Waiver of Responsibility *
Required
Press Waiver *
Required
Parent/Caregiver Digital Signature *
Your answer
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