Martensdale Community Church -

Vacation Bible School Registration

Please complete the form below and select the submit button to process. We will contact you to confirm the details of your registration. ** Please fill in all fields.

Name:

Address:

City:

State:

Zip:

Phone:

Grade going into next fall:

Email:

Emergency
Contact Name:

Emergency
Contact Phone:

Allergies/Allergic reaction child might have:

Doctors Name:

Doctors Phone:

© 2007 Martensdale Community Church - An Evangelical Free Church
Box 200 | Martensdale, IA 50160 | PH: 641.764.2491 | FX: 641.764.2443