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AWANA CLUBBER REGISTRATION
CALVARY ROAD BAPTIST CHURCH
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Clubs Begin September 9, 2009
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(All fields in red MUST be filled out in order to complete registration.)
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Parent / Guardian Information
Parent / Guardian(s):
(First, Middle, Last)
Home Address:
(Street, City, State, Zip)
Home Phone:
Contact Person:
Emergency Phone:
Emergency Contact:
Cell Phone:
Email:
Home Church:
(Current Church Membership)
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I am interested in helping:
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Weekly
Every Other Week
Monthly
Special Events
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Clubber / Child Information
Child Name:
(First, Middle, Last)
Nickname:
Birth Date:
Gender:
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Male
Female
School:
Grade:
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Sixth
Fifth
Fourth
Third
Second
First
Kindergarden
4 year old
3 year old
2 year old
Needs Book:
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Yes
No
Needs Uniform:
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Yes
No
Doctor:
(Name & Phone)
Dentist:
(Name & Phone)
Allergies / Meds Special Needs:
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Terms and Conditions:
(Click Here To Read)
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I have read and agree to the Terms and Conditions:
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Yes
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