GRACE BAPTIST CHURCH AWANA
VISITOR AND REGISTRATION INFORMATION Most questions need an answer put N/A if no answer applies.
Last Name
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First Name
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Gender
Parents’ or Guardians’ name (who child lives with)
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Street Address:
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City:
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Zip Code:
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Phone #:
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e-mail address:
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Church Your Family Attends:
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Childs' Age:
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Grade in School:
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Birth Date:
MM
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DD
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YYYY
Divorce Situation?:
Required
If YES please give information:
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Any Other Siblings in Awana? Please List Names:
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Emergency Phone #’s:
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Emergency Contact Person:
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Allergies: (If none please answer N/A)
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Does Your Child Have Any Physical Limitations?:
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Medication we need to be aware of:
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Where parent can be reached during club:
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I, _________________________ do hereby give Grace Baptist Church permission to have my child, medically treated in any necessary way while in their care. By signing this, I also release and do not hold liable Grace Baptist Church or their insurance company responsible for any accident that may occur. Parent Signature: _________________________________________
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Date
MM
/
DD
/
YYYY
Awana Form
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