Awana Contact Information
Clubber Name *
Your answer
Parent/Guardian Name(s) *
Your answer
Email *
Your answer
Street Address *
Your answer
Zip Code *
Your answer
Phone Number *
Your answer
Allergies (Food, Medicine) *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Club *
Required
Are you a member of a local church? *
Required
Emergency Contact (Name and Cell Phone) *
Your answer
Who is allowed to pick your child up? *
Other than parent/guardian named above who is allowed to pick up your clubber?
Your answer
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