AWANA Registration
2022 / 2023
Child's Name
*
First Name
Last Name
Child's birthdate
*
-
Month
-
Day
Year
Date
Age / Grade
*
4 year old
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Allergies / Medical Conditions we need to be aware of:
Parent / Guardian Name
*
First Name
Last Name
Parent / Guardian Cell
*
Please enter a valid phone number.
Emergency Contact
First Name
Last Name
Emergency Contact Cell
Please enter a valid phone number.
Does your child need GBC Bus transportation?
*
yes
no
Submit
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