Discipleship Weekend Registration 2022 – Second Avenue MBC

3045 W. Second Avenue

Corsicana, TX 75110

903-874-6813

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Service Times

3045 W. Second Avenue

Corsicana, TX 75110

903-874-6813

Upcoming Services:
Wednesday- 7 PM

Discipleship Weekend Signup

Child's Name*
Gender
- Male
- Female
Birthdate*
Date Format: MM slash DD slash YYYY
Grade Completed*
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Parent/Guardian*
Phone*
Email*
Alternative Emergency Contact*
Emergency Contact's Relationship To Child*
Emergency Contact's Phone*
Home Church
Food Allergies*
- Yes
- No
Allergies
Medical Concerns*
- Yes
- No
Medical Concerns Explained
Photo/Video Consent*
- Yes
- No
Permission for child to appear in photo and/or video documenting this event/weekend to be used at the discretion of Second Avenue MBC in its publications.

our building

3045 West 2nd Avenue

Corsicana, TX - 75110

reach us at

903-874-6813

Call us anytime

email us at

[email protected]

Write to us anytime