Excelsior Springs Baptist Church
Thursday, February 23, 2012
Christ Centered. Bible Believing. Family Focused.

AWANA 2011-2012 Registration


Child's Name   
 
 Date of Birth
 
Age  
 
Grade
 
Siblings Attending
 
Parent Name

Address 
 
City      
 
State   
 
Zip   
 
Home Phone 
 
Cell Phone 
 
Work Phone 
 
Church Home 
 
Emergency Contact (persons to contact in case parents cannot be reached)
 
Name  
Phone  
Relationship to Child
 
Name  
Phone  
Relationship to Child
 
Allergy/Health Conditions
 
My child has permission to attend and participate in AWANA for the  2011-2012 school year, a ministry of Excelsior Springs Baptist Church.
 
Yes
No
Date
 
My child has permission to be photographed/video graphed as part of AWANA
 
Yes
No
Date