Children's Ministries Registration

Parent/ Guardian Name Email Address Mailing Address City Zip Code Home Phone   Cell Phone Home Church     Alternate Emergency Contact Phone

Register for Last Name First Name Birth Date Gender Grade SS Awana * VBS 1 2 3 4

* Dues are $35 per child

Are there allergies or medical problems we should be aware of?

I grant my permisson for medical treatment and procedures as deemed necessary in case of an emergency.