Immanuel Baptist Church

CONNECT Registration

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Just Child(ren)

Child(ren) and Adults

Just Adults

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Last Name

Birthdate

Grade (incoming)

Allergies / Other Concerns

Program Selection

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Last Name

Phone Number

Email

Program Selection (for the Adult)

We need 2 adult Emergency Contacts

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Last Name

Phone Number

Relationship to Child

We need 2 adult Emergency Contacts

First Name

Last Name

Phone Number

Relationship to Child