Awana Registration Form | Dalzell Baptist Church

First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*

Email Address*

Phone*

Name of Child #1, Gender, Age, Grade, Date of Birth, and Known Allergies*

Name of child #2, Gender, Age, Grade, Date of Birth, and Known Allergies

Name of Child #3, Gender, Age, Grade, Date of Birth, and Known Allergies

Name of Child #4, Gender, Age, Grade, Date of Birth, and Known Allergies

Do you attend church? If so, where?*

Emergency Contact, Phone Number & Relationship to Child*

Do you consent to and approve you child/children to take part in any and all activities conducted by Dalzell Baptist Church Awana Club?*

Do you give permission for photos of your child/children to appear among other general club photos in any and all media as long as there is no identifying information published by Dalzell Baptist Church?*

Your Name will serve as your signature*