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EBC App
Ebenezer Baptist Church · Memphis
Youth
Praise Dancer
Application
To be completed by a parent or legal guardian. Takes a few minutes — everything goes straight to the ministry leaders.
🔒
Your child's information is not stored on this website.
It is emailed directly to the ministry leaders and nowhere else.
1 · Young person
Full name
Preferred name
Date of birth
Age / grade
T-shirt size
School
Home address
2 · Parent or guardian
Full name
Relationship
Primary phone
Alternate phone
Email address
Preferred contact
Call
Text
Email
3 · Interest and experience
Why would your child like to join?
Strengths, gifts or interests they would bring
4 · Health, safety and emergency
Emergency contact
Relationship
Emergency phone
Physician / phone
Allergies, medications, medical or physical conditions, sensory needs
Insurance provider
(optional)
Policy / group no.
(optional)
5 · Year-round availability
Recurring conflicts, custody arrangements affecting attendance, or transportation limits
6 · Parent / guardian permissions
7 · Photo and video
YES — EBC may photograph or record my child for ministry purposes.
NO — Do not photograph or record my child.
8 · Acknowledgment
I certify that the information provided is accurate and that I am authorized to give permission for this child.
Parent / guardian signature (type your full name)
💜 Submit Application
Goes to Brandi Mosby, Praise Dance Ministry, with Jheri Williams copied. Not stored on this site.
💜
Application received.
The ministry leaders have your application and will be in touch with you directly. Thank you for entrusting your child to this ministry.
Prefer paper?
Download the Word application
Questions?
Email Brandi Mosby
Open the EBC Memphis app →