Awana Registration
First Date: September 15, 6:30 pm - 8:00 pm
Address: N1640 Ryan Rd, Lodi, WI 53555
Questions? Contact us at (608) 592-3091
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Email *
Parent/Guardian Name *
Parent/Guardian Address *
Parent/Guardian Phone *
Persons (other than parents) authorized to pick up your child(ren):
Emergency Contact Name *
Emergency Contact Phone *
Doctor Name and Contact
Dentist Name and Contact
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