Awana Clubs Contact Information and Permission Authorization
Address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone number:
*
Parent/Guardian name:
*
Clubber name:
*
Clubber birthday:
*
-
Month
-
Day
Year
Date
Clubber age/grade: both required
*
Siblings (names/ages):
Hobbies/Activities:
Church:
Medical conditions:
*
Brought by (transportation):
Invited by:
Individuals authorized to pick up child from club:
*
Leader's signature and date
Parent/Guardian signature and date
Awana Clubs Contact Information and Permission Authorization
Type
1. Written 1. Achievement or Attendance
2. Visit 2. Get Well or Encouragement
3. Phone 3. Invitation to Club Activity
4. Birthday or Celebration
5. Other (Specify)
Submit
Should be Empty: