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AWANA Registration -2016
Child First Name *
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Child Last Name *
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Parent/Guardian First Name *
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Parent/Guardian Last Name *
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Parent/Guardian Cell Phone *
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Parent/Guardian Work/Home Phone
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Parent/Guardian Email *
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Street Address *
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City *
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Zip *
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Birthdate of Child *
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Grade of Child *
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Gender of Child *
Medical Information *
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Are you a member of a church...where? *
Interested in helping? *
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