SEBC Awana Clubber Registration 2019-2020
506 Carrollton Drive
Frederick, MD 21701
Parent / Legal Guardian 1 First Name *
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Parent / Legal Guardian 1 Last Name *
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Parent / Legal Guardian 2 First Name
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Parent / Legal Guardian 2 Last Name
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Street Address *
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City *
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State *
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Zip Code *
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Home Church
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Persons (Other than parents / guardians) authorized to pick up your children
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Email Address 1 *
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Email Address 2
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Cell Phone 1 xxx-xxx-xxxx *
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Cell Phone 2 xxx-xxx-xxxx
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Home Phone xxx-xxx-xxxx
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Emergency Contact Name (other than parents/guardians) *
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Emergency Contact Relationship *
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Emergency Contact Phone Number xxx-xxx-xxxx *
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