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"Why Not Wednesdays?" WEBC KIDS Registration
Event Timing: Wednesdays @ 6:30-8:00pm
Event Address: West Edgecombe Baptist Church
13821 NC 43 N
Rocky Mount, North Carolina 27801
Contact us at
Children@westedgecombebaptist.com
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* Indicates required question
Child's First Name
*
Your answer
Child's Last Name
*
Your answer
Gender
*
Female
Male
Birthdate
*
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/
DD
/
YYYY
Current Grade (if applicable)
Kindergarten
First Grade
Second Grade
Third Grade
Fourth Grade
Fifth Grade
Sixth Grade
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Address, City, State, Zip Code
*
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Parent's Name and Phone Number
*
Your answer
Parent or Guardian's Email
*
Your answer
Emergency Contact's Name and Phone Number
*
Your answer
Does your child have any allergies?
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No
If you checked "YES" to allergies, please explain here:
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Is there anything additional we need to know about your child?
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