Weirton Nazarene Church
Friday, June 22, 2018
Come Journey with Us!
 

               Sunday, June 24th - Wednesday, June 27th 

                                      6:30 pm Each Night

                                                                   (Ages 3 yrs through 6th Grade)

TO REGISTER FOR WEIRTON NAZARENE'S 2018 TIME LAB VBS, COMPLETE THE FOLLOWING FIELDS AND THEN SELECT "SUBMIT": 

Child Name:  Birthdate:  Grade Completed:
Child Name:  Birthdate:  Grade Completed:
Child Name:  Birthdate:  Grade Completed:
Child Name:  Birthdate:  Grade Completed:
Child Name:  Birthdate:  Grade Completed:
 
Parent(s) Name:
Address:                  
Phone:                         Email:      
                                                                                                                                                                                                         By providing an e-mail address you will receive a copy of the form after you select "Submit."
 
Who is permitted to pick up your child/children?:          
Emergency Contact:      Emergency Phone:     
Allergies or Medical Conditions:       
 
Comments or Questions: