IBC K12 Moms Registration 2023-2024

Today's Date

Name

This address will receive a confirmation email

Cell Phone

Address

Birth Date

Children's Names & Birth Dates

Husband's Name (if applicable)

Home Church (if applicable)

How did you hear about us?

Scholarship Please contact me with scholarship info.

2023/24 Registration Options

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Description

Please fill out this form and click submit. K12 Moms is for any mom of school-age children/teens. Please note that childcare is not provided.