Printed on 5/4/12
AWANA REGISTRATION
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REGISTRATION FORM FOR GALILEE BAPTIST AWANA CLUBS
Please complete all applicable fields.
Household Name:
Street Address Line 1:
Street Address Line 2:
City:
State:
Zip Code:
Household Phone:
Household Email:
Home Church:
Primary Parent/Guardian #1 First Name, Last Name:
Primary Parent/Guardian #1 Cell Phone:
Primary Parent/Guardian #1 Relationship:
Secondary Parent/Guardian #2 First Name, Last Name:
Secondary Parent/Guardian #2 Cell Phone:
Secondary Parent/Guardian #2 Relationship:
Parent/Guardian #3 First Name, Last Name:
Parent/Guardian #3 Cell Phone:
Parent/Guardian #3 Relationship:
Student #1 First Name, Last Name:
Student #1 Grade:
Student #1 Gender:
Student #1 Birth Date MM/DD/YYYY:
-
Student #2 First Name, Last Name:
Student #2 Grade:
Student #2 Gender:
Student #2 Birth Date MM/DD/YYYY:
Student #3 First Name, Last Name:
Student #3 Grade:
Student #3 Gender:
Student #3 Birth Date MM/DD/YYYY:
Student #4 First Name, Last Name:
Student #4 Grade:
Student #4 Gender:
Student #4 Birth Date MM/DD/YYYY:
Student #5 First Name, Last Name:
Student #5 Grade:
Student #5 Gender:
Student #5 Birth Date MM/DD/YYYY:
Student #6 First Name, Last Name:
Student #6 Grade:
Student #6 Gender:
Student #6 Birth Date MM/DD/YYYY:
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