2017-18 - LCF Awana Online Registration

Please enter the information below.  You must enter the text you see in the CAPTCHA text window before clicking the Submit button.  This helps reduce unwanted submissions from spamming.  Click on a field or press the [Tab] key for the next field. Pressing [Enter] is the same as clicking the [Submit] key.

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Child’s Name:

Parent/Guardian Name(s):

Parent/Guardian Primary Phone:

Parent/Guardian Secondary Phone:

Mailing Address:

Home Email Address:

Child’s Birth Date:

Child’s Gender:

Uniform Size:

Church your family attends (if any):

In case of emergency (when the parent/guardian cannot be reached) the church should contact:

Name:

Telephone:

Relationship to Child:

Please list any allergies, medical or other special conditions the Awana Leaders should be aware of:

Other individuals that may be responsible for picking up this child at the end of Awana club night:

Name:

Telephone:

Relationship to Child:

Message:

Enter the text you see below

Child’s Grade:

Family Physician:

Physician’s Phone:

Format: mm/dd/yyyy

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