CHBC Student Registration

AWANA Registration

Cheatham Hill Baptist Church
Asterisk "*" indicates required field.
Student Full Name *

First Name Last Name

Student Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Home Phone *

Area Code Phone Number
Additional Phone

Area Code Phone Number
School Grade *
Does Student Attend Church?

YES NO
Permission to Photograph Student? *

YES NO
Student Birth Date (MM-DD-YYYY) *
Parent or Guardian Full Name *

First Name Last Name
Relationship to Student
Parent/Guardian Email
Authorized Person to Pickup Student *

First Name Last Name
Authorized Person to Pickup Student

First Name Last Name
Authorized Person to Pickup Student

First Name Last Name
Emergency Contact Full Name *

First Name Last Name

Emergency Contact Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Emergency Contact Phone *

Area Code Phone Number
Emergency Contact - Alternate Phone

Area Code Phone Number
Student's Medical Issues *
Prescribed Meds (Please List) *
Allergies *
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