SHBC Awana Registration
Please contact Jeb Berleth with any questions or inquiries.
Email address *
Child's Name *
Your answer
Child's Birth Date *
MM
/
DD
/
YYYY
Child's Grade (Upcoming Year) *
Child's Home Address *
Your answer
Home Phone # *
Your answer
Parent's Name *
Your answer
Parent's Cell Phone # *
Your answer
Emergency Contact Name *
Your answer
Emergency Contact's Relationship to the Child *
Your answer
Emergency Contact's Phone # *
Your answer
Emergency Contact's Address *
Your answer
Another Person Allowed to Pick Up Your Child *
Your answer
Pick Up Person's Contact Phone # *
Your answer
Child's Medical Conditions/Allergies/Other...
Your answer
Photographs are sometimes taken of children’s ministry activities for publicity and promotional purposes, which include, but are not limited to, in-house presentations, church web sites, brochures and newsletters. Children’s names or information are never used without specific permission. By typing your name below, you are releasing Spring Hill Baptist to use photographs of your child as stated above. *If you do not wish for photos of your children to be taken and used for promotional purposes please choose "no" for this question. *
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