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