EBC MOMS' Group: Winter/Spring 2023 Registration Form (with childcare)

Friday, January 27, 9 AM | Thank you for registering for Moms' Group! Please fill out this form and click Submit.

Name:

Email:

This address will receive a confirmation email

Phone Number:

Secondary Phone:

Address:

Church affiliation:

Please select all that apply.

Member at EBC Attend at EBC Attend another church Currently do not attend a church

Childcare Registration:

Please list ALL of your children below, even if they will not be attending moms' group with you. Don't forget to enter each child's age and birth date. This helps us greatly when planning childcare. Thank you!

Child's Name:

Birthdate:

Age:

Child attending with you?

Please select all that apply.

Yes No

Child's Name:

Birthdate:

Age:

Child attending with you?

Please select all that apply.

Yes No

Child's Name:

Birthdate:

Age:

Child attending with you?

Please select all that apply.

Yes No

Child's Name:

Birthdate:

Age:

Child attending with you?

Please select all that apply.

Yes No

Child's Name:

Birthdate:

Age:

Child attending with you?

Please select all that apply.

Yes No

If you have additional children, please list their information here:

Do any of your children have any type of allergies or medical needs? (inhaler, food allergy, etc.) If so, please list specifics below.

Please indicate if you authorize us to share the information on this form with the other Moms’ Group members.

Please select all that apply.

Yes No

Description

Friday, January 27, 9 AM

Thank you for registering for Moms' Group! Please fill out this form and click Submit.

EBC MOMS' Group: Winter/Spring 2023 Registration Form (with childcare)

Description

Please Fix the Following