New Ebenezer Baptist Church Back to School Sleepover Extravaganza!!
Date: Friday, August 16, 2019 Until Saturday, August 17, 2019
Where: SHEREC of New Ebenezer Baptist Church

Arrival time: 6:00 pm, Fri., August 16th
Departure time: 8:00 am, Sat., August 19th

Complete the form below to register your child(ren) for this event.
*If your child is driving we must have written consent prior to the night of the event Rev. Sandra Carter for information.

Child's Name *
Your answer
Age *
Your answer
Parent/Guardian *
Your answer
Address
Your answer
Home Phone Number *
Your answer
Cell Phone Number *
Your answer
Work Phone Number *
Your answer
Medical Information *
Allergies or other Health Problems
Your answer
Hospital Preference *
Your answer
Who can pick up your child(ren) if you are not available? *
(Please list two adults names and a contact telephone number for each adult listed. .)
Your answer
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