Jersey Baptist Church

Contacts

Church Office 740.927.1859

Debbie Zachariah x102
Director

Ryan Morris
Associate Director

Nikki Carr x205
Ministry Suport - Preschool

Sheri Wade x120
Ministry Suport

Awana Registration

Awana Registration

Parent/Guardian Name (First and Last) *

Street Address *

City *

ZIP Code *

Home Phone *

Email *

Cell Phone

Emergency Contact *

Emergency Contact Phone *

Who May Pick Up Your Child?

Who May NOT Pick Up Your Child?

Do You Attend Church?

If so, Where? *

Child #1

Child's Name (First and Last) *

Current Grade *

Birth Month *

Birth Day *

Birth Year *

Medical Information We May Need to Know

Child #2

Child's Name (First and Last)

Current Grade

Birth Month

Birth Day

Birth Year

Medical Information We May Need to Know

Child #3

Child's Name (First and Last)

Current Grade

Birth Month

Birth Day

Birth Year

Medical Information We May Need to Know