AWANA Registration Form
Fill out as indicated and submit at bottom of form
Child’s Name: *
Your answer
Birth Date:
Your answer
Age: *
Your answer
School Grade: *
School Attending:
Your answer
Parent(s) or Guardian(s) Name(s): *
Your answer
Home Address: *
Street, City, State, Zip
Your answer
Phone Numbers: *
Home and mobile
Your answer
Email:
Your answer
Brought by: (Sponsor) *
Your answer
Photo Hide
If you DO NOT want your Child’s Photo on our Web Page, Please put your name in the box below
Your answer
Emergency Contact Information: *
Name: Relationship: Phone #(during AWANA)
Your answer
Member of Southridge
Church Attending:
Your answer
Food Allergies: *
If none, write none
Your answer
Other Health Concerns: *
(Describe)
Your answer
Submit
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