AWANA PRE – REGISTRATION

Child's First Name *

Child's Last Name *

Gender (M/F) *

Child's Age *

Child's School Grade Level *

Child's Date of Birth *

Child's Main Contact Phone Number *

Child's Mother's Name *

Mother's Phone Number *

Child's Father's Name *

Father's Phone Number

Parent's Email (required) *

Additional Email (required)

Does child need transportation? (YES or NO) *

Who invited you to LBC?

What church do you regularly attend?

Does child have any known food / medication allergies or other special needs? *