Father's Name

 

Child's Name

 

Address  

 

Address  

 

City

 

State

 

Zip

 

Phone

 

Email Address

 

Is your Child a returning Club Member?  Yes      No 

 

Grade attending for 2013-2014   

 

Date Of Birth

 

If Pre-K, Age on September 1st  

 

Gender:    Male        Female 

 

Home Church 

 

Have you been involved with an Awana program before?    Yes      No 

 

If so, which Church?    

 

In what city?