Pioneers — Tidewater Baptist Church

Tidewater Baptist Church

1316 Campostella Rd.
Chesapeake, VA 23320

757-545-7282

Pioneer Club Registration 2025-2026

First Name

Last Name

Age, Birthdate and Grade

Brothers & Sisters also wanting to register with names and age/dob/grade

Parent or Guardian Information

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

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Email

My child has the following allergies, medical concerns, or special learning needs:

Emergency Contact if parent cannot be reached:

First Name

Last Name

Phone

(###)

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We look forward to seeing you September 3rd. Any questions?