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AWANA Registration Form
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* Indicates required question
Child’s Name:
*
Your answer
Birth Date:
Your answer
Age:
*
Your answer
School Grade:
*
5
K
3
2
6
4
1
School Attending:
Your answer
Parent(s) or Guardian(s) Name(s):
*
Your answer
Home Address:
*
Street, City, State, Zip
Your answer
Phone Numbers:
*
Home and mobile
Your answer
Email:
Your answer
Brought by: (Sponsor)
*
Your answer
Photo Hide
If you DO NOT want your Child’s Photo on our Web Page, Please put your name in the box below
Your answer
Emergency Contact Information:
*
Name: Relationship: Phone #(during AWANA)
Your answer
Member of Southridge
Yes
No
Clear selection
Church Attending:
Your answer
Food Allergies:
*
If none, write none
Your answer
Other Health Concerns:
*
(Describe)
Your answer
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