AWANA 2018-2019 Registration
Please fill out one registration form per child. Thanks!
First Name of Child
Your answer
Last Name of Child
Your answer
Birthday
MM
/
DD
/
YYYY
Age
Your answer
Current Grade in School
School
Your answer
Mailing Address (please include town and zipcode if it is not Burlington, WI 53105)
Your answer
Parents or Guardians Names
Your answer
Phone Number
Your answer
Other Phone Number
Your answer
In case you can't be reached at the listed phone numbers, please list an emergency contact name, relationship, and phone number.
Your answer
Email Address
Your answer
Allergies/Health Concerns:
Your answer
Please share any other information that might help us encourage and work with your child.
Your answer
Where do you worship?
Could we share AWANA photos including your child on Faith Chapel’s social media? *
Please "sign" your name and date to give your child permission to participate in Faith Chapel's AWANA program.
Your answer
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