AWANA Club Registration Form
Ages: K-5 Wednesdays (Sept-Nov) 6-7:30pm
Email address *
Child's Name *
Your answer
Birthdate: *
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YYYY
Current Grade: *
EMERGENCY CONTACT INFORMATION
Parent/Guardian Name: *
Your answer
Parent/Guardian Phone # *
Your answer
Secondary Contact Name:
Your answer
Secondary Contact Phone #
Your answer
Allergies *
Required
If YES, please list details below.
Your answer
Additional Info.
Your answer
Child's Name
Your answer
Parent/Guardian Name
Your answer
Date:
MM
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DD
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YYYY
A copy of your responses will be emailed to the address you provided.
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