Awana Clubs Contact Information and Permission Authorization
Clubber Name: *
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Parent/Guardian Name: *
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Address: *
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Phone Number: *
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Clubber Birthday: *
MM
/
DD
/
YYYY
Clubber Age/Grade: *
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Siblings (names/ages): *
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Church: *
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Medical Conditions: *
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Brought by(transportation):
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Invited By:
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Individuals authorized to pick up child from club: *
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