2022/23 EBC Kids Registration Form
Please fill out this form and click submit.
The purpose of this form is to keep up to date information on the members of our body, to allow more efficient communication to specific groups with information pertinent to them. We do not sell or distribute your information. It is for internal use only.
Parent Name
*
Email
*
This address will receive a confirmation email
Cell Phone
*
Text?
Please select all that apply.
Yes
No
Mailing Address
*
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AA
AB
AE
AK
AL
AP
AR
AS
AZ
BC
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
YT
Spouses Name
Email
Cell Phone
Text?
Please select one option.
Yes
No
Option
Child #1 Name
Age?
*
Date of Birth
Grade
School
Allergies/Special Needs/Concerns
Child #2 Name
Age?
Date of Birth
Grade
School
Allergies/Special Needs/Concerns
Child #3 Name
Age
Date of Birth
Grade
School
Allergies/Special Needs/Concerns
Child #4 Name
Age
Date of Birth
Grade
School
Allergies/Special Needs/Concerns
I give permission to Eliot Baptist Church to use both images and/or sound clips of my child/children in part or in whole for printed publications, website use or other public viewing.
*
Please select all that apply.
Yes
No
Submit
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