2018 Summer Enrichment Program Student Application
Lilly Grove Missionary Baptist Church
Rev. Terry K. Anderson, Senior Pastor
Rev. Carlos Washington, Associate Pastor
Email address *
By entering your email address above, you will receive a copy of the completed application.
Last Name *
Your answer
First Name *
Your answer
Date of Birth *
Age *
School(s) Attended in 2017-18 School Year/Dates *
Your answer
Grade Level - August 2018 *
Select T-shirt/Polo-Style Size (Y=youth, A=Adult) *
Our goal is to provide a positive and enriching experience for your child. You can help us by providing as much information as possible. Please give information about any special concerns, education modifications, and medical needs including: allergies, existing illnesses, previous serious illnesses, disabilities, continuous use of medication. *
Your answer
Is this the first year your child will participate in the Summer Enrichment Program (SEP)? *
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service