Awana Club Registration
Child's name
Child's birth date (MM/DD/YY)
Grade
School child attends
Child's home address
City, ST Zip
Child's phone
Child's e-mail
Church child regularly attends
Mother's name
Mother's e-mail
Mother's address (if different)
Mother's City, ST ZIP (if diff.)
Mother's home phone (if different)
Mother's Cell Phone
Mother's Work Phone
Church that mother regularly attends
Mother would like to learn more about Children's Ministry at Shadycrest Baptisit Church
Mother may be interested in serving in Children's Ministry at Shadycrest Baptist Church
Father's Name
Father's e-mail
Father's home address (if different)
Father's City, ST ZIP (if different)
Father's home phone (if different)
Father's work phone
Father's cell phone
Church father regularly attends
Father would like to learn more about Children's Ministry at Shadycrest Baptist Church
Father would be interested in serving Children's Ministry at Shadycrest Baptist Church
Name of other person that may pick up your child
Their address
Their City, ST ZIP
Relationship to child
Do you agree to allow your child to be photographed for promotional purposes?	yes no
Name of person granting or denying permission