AWANA Registration

Pleasant Grove Baptist Church Awana Registration Form

2011 - 2012

Parent/Guardian Number/E-Mail Address Contact Person

Name(s): Home Phone:

Address: Work Phone:

City: State: Zip: Cell Phone:

Family Church: E-Mail:

Persons (other than parents) authorized to pick up the children: Other:

Emergency*:

*Emergency Contact During Club Time (other than parents)

Child's Name (First, Middle, Last) Nickname Birth Date Gender Grade School Need Book Need Uniform Size

Clubber Doctor Name and Phone Dentist Name and Phone Allergies / Meds / Special Needs

I am interested in helping: Weekly Every Other Week Monthly For Special Events

Note: All Awana Club leaders and listeners must submit to a background check before working with the children.

After the form is submitted, please see Rusty Currence to sign the consent forms.