© 2008 Adina Digital Experience
Transportation: Provide Own Or Ride Needed If Ride Needed:
Name
Parent/Guardian
Address
City
Phone: Home
Work
Cell
E-Mail
Do You Attend Church?
If Yes, Where?
Birth date, Preschoolers Only
Others, Last Grade Completed
Emergency Contact
Phone
Medical Information, Food Allergies, etc...
Drop-Off Location If Different
Pick-Up Location If Different From Above
Contact: Eastland Baptist Church, PO Box 825, 1229 East High Street, Bryan, OH 43506
Phone: 419-636-3835 or register online at ebcbryan.com
