2018-2019 AWANA REGISTRATION FORM
CBIC CHURCH, 465 CENTER STREET, CHAMBERSBURG PA 17201 WWW.CHAMBERSBURGBIC.ORG

FOR CHILDREN AGES 3 1/2 (BORN BEFORE 4/3/2015) AND FULLY POTTY TRAINED - 5TH GRADE

Child's Name *
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Child's Age *ages 3 1/2 (and must be fully potty trained) - 5th Grade *
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Child's Birthday *
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Child's Grade *
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Child's Gender *
Parent's/Guardian's Name *
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Mobile Number *
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Address *
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Email Address *
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Church Currently Attending
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Allergies/Medical Conditions
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Emergency Contact *
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Emergency Contact Number *
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By clicking submit you are agreeing to hold Chambersburg Brethren in Christ Church, its employees and volunteers harmless in regard to loss or damage to property or person.
RELEASE TO USE PHOTO & VIDEO IMAGES: The undersigned consents to & authorizes the use of Chambersburg Brethren in Christ Church to any and all photographs and video images taken during church functions. The use of these images is at the discretion of Chambersburg Brethren in Christ Church for promotional purposes without compensation to the undersigned.
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