Awana Registration

Belmont Baptist Church · Wednesday nights, August–May

Clubber

First name

Last name

Sex

Male Female

Birthdate

Grade (as of Sept 1)

T-shirt size

Allergies (if any) Siblings (name / age)

Home address Street

City

State

ZIP

Parent / guardian

First name

Last name

Cell phone

Home phone

Preferred contact

Call cell Text cell Email

Church you attend

Emergency & pickup

Emergency contact name

Relationship

Emergency contact phone Who may pick up your child (besides you) Special concerns or instructions

Text message updates

Photo permission

Your information is saved securely to the church’s Awana database.

Registration received!