Awana Registration

* Name:


First Name	Last

* Date of Birth:

* Age:

* Gender:

* Address:

Apt #:

* City:

* State:

* Zip:

* Primary Phone:

format : XXX-XXX-XXXX

Secondary Phone:

format : XXX-XXX-XXXX

* Email Address:

* Name of Home Church:

* Grade:

* Name of Parent/Guardian:


First Name	Last

Name of a Parent/Guardian/Friend who will pick the child up:


First Name	Last	Relation

* Does the child need a uniform:

* Uniform Size (If Needed):

* Does the child need an AWANA book:

* Enter image code:

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