eGAMES 2022

Parent Name

Parent Cell Phone

This address will receive a confirmation email

Students

Please register each student. If you have more than 4 students to register please complete the form twice.

Student #1

Student #2

Student #3

Student #4

Do any of your students have allergies? If so, please explain

Payment

We never want finances to keep a teen from attending one of our trips or events. Please email Pastor Matt (mostrow@ebbcpa.org) if you need assistance and select pay later below.

Payment (Friends are FREE!)

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Description

September 9th, 10th, 11th, 2022 6-9pm

Thanks for signing up for our eGAMES!

eGAMES 2022

Description

Please Fix the Following