Zanesville Northside Church of the Nazarene

V.B.S. Registration Form | July 29th - August 2nd

Child's Name: *

Child's Birth Date:

Child's Age: *

Child's Grade: *

Parent/Guardian Name: *

Phone Number: *

Street Address: *

City: *

State: *

Zip Code: *

Email Address:

Medical Information/Other Information (Food or any allergies, etc):

Who may pick up the student at dismissal if other than name listed above?

May we have permission to take photos for promotion or social media? *

Yes

If you are visiting, would you like more information about our church?

Yes

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