Reynolds Baptist Church
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AWANA Registration Form
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Indicates required field
Clubber's Name
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First
Last
Birthdate
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Age
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Medical Conditions or Allergies
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Grade in School
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Clubber #2 (if more than one child)
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First
Last
Medical Conditions or Allergies ( Clubber #2)
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Birthdate
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Age
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Grade in School
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Clubber #3 (if more than two children)
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First
Last
Clubber #3 Medical Conditions or Allergies
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Birthdate
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Age
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Grade in School
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Physical Address
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Mailing Address if Different From Physical Address
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Parent/Guardian(s)
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E-mail address (Parent or Guardian)
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Home Phone
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Cell Phone
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Church
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Individuals authorized to pick up child from club
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Parent Signature
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Authorization of Typed Signature
By typing my name to the signature line, I confirm that I am the parent of the child (children) listed above and I wish to enroll them in the AWANA program at Reynolds Baptist Church
Submit