Vicksburg Bible Church AWANA Registration for 2018-2019 School Year
Kindly use drop down menus, check boxes and tabs to input your data. Select "SUBMIT" when you are finished. Your registration will be complete when you sign the liability waiver at the first AWANA meeting Tuesday September 11th, 2018.
Email address *
Family Last Name *
Your answer
Best Family Phone Number (ie. 269-123-4567) *
Your answer
Mother's Last Name (If different than child)
Your answer
Mother's First Name
Your answer
Mother's Cell Phone Number (ie. 269-123-4567)
Your answer
Father's Last Name (If different than child)
Your answer
Father's First Name
Your answer
Father's Cell Phone Number (ie. 269-123-4567)
Your answer
Street Address *
Your answer
City *
Your answer
Zip Code *
Your answer
Mailing Address (If different than above)
Your answer
Emergency Contact (Name - Relationship) *
Your answer
Emergency Contact Phone Number (Please Note if home or cell number) *
Your answer
The following persons have permission to pick up my child(ren) from AWANA: (Name/ Cell Phone Number)
Your answer
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