AWANA Club 581 Online Registration
Email address *
Parent/Guardian First Name: *
Parent/Guardian Last Name: *
Address: *
City *
Zip Code *
State *
Cell number *
Email address *
What is your home church? *
Emergency Contact Name *
Emergency Contact Number *
Child's first name *
Child's last name *
Birth date *
MM
/
DD
/
YYYY
Gender *
Needs book & shirt *
Yes
No
Book
Shirt
Allergies [please list below] *
Special needs *
Required
Attended other AWANA Clubs *
Required
Are you interested in helping:
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