Register for
PBC Kids Worship.

Fill out the form below to let us know if your child will be participating in our PBC Kids Worship program.

Parent Name

First Name

Last Name

Parent Email

Parent Phone Number

(###)

###

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Secondary Emergency Contact Phone Number

(###)

###

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Please list the name and grade of all of your children below (separate by commas)

ie. John Smith 5th grade, Jane Smith 1st grade

Please list all medical or allergy information below: