Summer Session Registration – Providence Baptist Church

Please submit a separate form for each child you are registering.

(* Required)

Personal Information:

Child's Name:*

First Last

Gender?*

Male
Female

Child's date of Birth?*

Age Group:*

Please select the age / group of your child, as of August 31, 2023.

Are you a Providence Baptist Church member?*

Yes
No

Do you currently have a child enrolled with us?*

Yes
No

Primary Parent Name:*

Prefix First Last

Relationship to Child?*

Primary Contact Phone:*

Primary Email:*

Enter Email Confirm Email

Secondary Parent Name:

Prefix First Last

Relationship to Child?

Secondary Contact Phone:

Secondary Email:

Enter Email Confirm Email

Primary Address:*

Street Address Address Line 2 City State Zip Code Country

Registration Fee:

You can choose to register your child for one or both sessions. There is a non-refundable enrollment fee of $85/ child, whether your child is attending one or two sessions. In addition to the registration fee, you also must pay the program fee upfront.

*No Preschool 6/17-21 due to Vacation Bible School (K-5th grade completed).