SHBC Awana Clubs Registration Form
Please contact Jeb Berleth with any questions or inquiries.
Email address *
Child's Name *
Child's Birth Date *
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DD
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Child's Grade (Upcoming Year) *
Child's Home Address *
Home Phone *
Parent's Name *
Parent's CELL Phone Number *
Emergency Contact Name *
Emergency Contact Relationship to the Child *
Emergency Contact Phone Number *
Emergency Contact Address *
Another Person Allowed to Pick Your Child *
Pick Up Person's Contact Phone Number *
Child Medical Conditions / Allergies / Other...
Photographs are sometimes taken of children’s ministry activities for publicity and promotional purposes,which include, but are not limited to, in-house presentations, church web sites, brochures and newsletters. Children’s names or information are never used without specific permission. By typing your name below, you are releasing Spring Hill Baptist to use photographs of your child as stated above. If you do not wish for photos of your children to be taken and used for promotional purposes please skip this question. *
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