Name:            Parent/Guardian: 

 

Child's Birthdate: 

 

Mailing Address: 

 

City/State/Zip: 

Home Phone:                      Email: 

 

Cell Phone: 

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Emergency Contact: 

 

Emergency Phone: 

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Do you have an AWANA Uniform?

 

Yes        No  

 

Are you currently working in an AWANA Handbook?

 

Cubbie       Sparks        Truth & Training   

 

Home Church: 

     

Are there any additional comments you would like to make

regarding your child and their needs:

               

 

All fields must be completed to send form. If question does not apply please put none in box.