Awana Registration (2017-2018)
First Name *
Your answer
Last Name *
Your answer
Male or Female *
Birth date: *
MM
/
DD
/
YYYY
Grade *
T-Shirt Type: Youth or Adult *
T-Shirt Size: *
Mailing Address: *
Your answer
City *
Your answer
Zip Code *
Your answer
Physical Address: *
Your answer
City *
Your answer
Zip Code *
Your answer
Email Address: *
Your answer
Parent/Guardian (1) Name: *
Your answer
Relationship to Student: *
Your answer
Parent/ Guardian (1) Phone: *
Your answer
Parent/Guardian (2) Name:
Your answer
Relationship to Student:
Your answer
Parent/Guardian (2) Phone:
Your answer
Do you attend Church? If so, Where? *
Your answer
Student may be picked up by:
Name and Phone # *
Your answer
Name and Phone # *
Your answer
Name and Phone # *
Your answer
Please feel free to disclose any other information you feel we need to know regarding the care of your child.
Your answer
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