Lewis Memorial Baptist Church (LMBC): pastor - Dr. David Lemming, Huntington, WV

parent/guardian name(s)

address

city, state, zip
    
phone


church name
member?

child's Name

birthday, age, grade (for '08-'09)
   4 5 6 7 8 9 10 11    Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade

emergency contact

contact phone


*allergies or medications
None

*optional