2011-12 AWANA Registration
* Child's Full Name
* Child's Date of Birth
* Child's Age
* School Grade
* School Attending
* Parent/Guardian's Full Name
* Street Address
* Zip Code
Medical Conditions we should be aware of?
Custodial issues we should be aware of?
Anyone forbidden by court order to pick up your child? If so, who?
* Actively involved in a local church?
* Medical consent: In the event of a medical emergency, I give CBC and its representatives permission to seek medical attention for my child.
* If I am unable to be reached, I give CBC & its representatives permission to act in my stead until I can be notified.
By entering my full name below, this serves as my electronic signature, verifying my consent that all information is correct and valid.
* Electronic Signature-enter full name of parent/guardian
The image below ONLY contains letters.
* Letters in image:
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Clearwater Baptist Church
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