2011 AWANA Registration Form

Parent/Guardian Name(s):

Address:

City:

State:

Zip:

Phone Number:

Emergency Phone Number (during Awana):

Email Address:

Child's Name:

Birthdate:

Boy or Girl?:

Grade in Fall 2011?:

Home Church:

2nd Child's Name (If applicable):

Birthdate:

Boy or Girl?:

Grade in Fall 2011?:

3rd Child's Name (If applicable):

Birthdate:

Boy or Girl?:

Grade in Fall 2011?:

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