Pleasant Hill Kids’ Club
Sunday’s from 5:30-7:30 P.M.
Child's Name:
Age:
Date of Birth:
Grade for 2020-2021:
Please Select
Pre-K
Kindergarten
Fitst Grade
Second Grade
Third Grade
Fourth Grade
Fifth Grade
Street Address:
City/State/Zip code:
Shirt Size:
Please Select
Child Small (4)
Child Medium (5)
Child Large (6)
Child X-Large (8)
Youth Small (10)
Youth Medium (12)
Youth Large (14)
Adult Small
Adult Medium
Adult Large
Adult X-Large
Mother's Name:
Mother's Cellphone Number:
Father's Name:
Father's Cellphone Number:
Primary Email Address:
In Case of Emergency, Contact:
Emergency Contact Phone Number:
Allergies or Other Medical Conditions:
Home Church:
When you bring your child we will have a Release Form the parent or legal guardian must sign in order for your church to participate in AWANA
Submit
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