Awana Registration
Westchester Baptist Church
Child's Name
First Name
Last Name
Birthday
-
Month
-
Day
Year
Date
Grade
Preschool (child must be at least 3 years old)
Kindergarten
1st
2nd
3rd
4th
5th
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent Name 1
*
Phone Number 1
*
Please enter a valid phone number.
Format: (000) 000-0000.
Parent Name 2
Phone Number 2
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact if a parent cannot be reached.
Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Does your child have allergies or medical conditions that we should be aware of?
*
YES
NO
If you answered YES, please explain below:
Do you give consent for photos/videos being taken of your child for use on our website/social media?
YES
NO
Submit
Should be Empty: