Contact Information
First Landmark Baptist Church AWANA Registration
AWANA Popsicle Launch/Registration Party is Wednesday, August 16, 6:00 p.m.
Fall 2017 Club Nights are Wednesday, August 23-December 13, 6:00-7:30 p.m.
Email address
Student's Name (First & Last)
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Student's Date of Birth
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Physical Address & Mailing Address (City, State, Zip)
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Age/Grade for 2017-2018 School Year
Parent/Guardian Name:
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Parent/Guardian Phone Number
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Student's Allergies, Illness, or Other Conditions
Your answer
Emergency Contact (Other Than Yourself)
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Home Church
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Authorized People to Pick Up Your Child (Name & Phone Number)
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