Grace Bible Church - Discover the Joy!

AWANA Clubber Registration

All information submitted in this form will be sent to Grace Bible Church of Homosassa and kept confidential.

* Indicates required fields.

Parent/Guardian Information
*Name(s):
Address:
City:
State: Zip:
Family Church:
Persons (other than parents) authorized to pick up the children:
  Number/Email address Contact Person
*Home Phone:
Work Phone:
Cell Phone:
E-Mail:
Other:
Emergency*:
*Emergency Contact During Club Time (other than parents)
I am interested in helping: Weekly Every other week Monthly For Special Events
Note: All Awana Club leaders and listeners must submit to a background check before working with the children.
Please give written directions to your home:
(This is required in case we would ever have to bring your child home.)
1st Clubber Information
*Child's Name (First, Middle, Last) Nickname Birth Date Gender
School Grade Need Book Need Uniform
Allergies / Meds / Special Needs
2nd Clubber Information
Child's Name (First, Middle, Last) Nickname Birth Date Gender
School Grade Need Book Need Uniform
Allergies / Meds / Special Needs
3rd Clubber Information
*Child's Name (First, Middle, Last) Nickname Birth Date Gender
School Grade Need Book Need Uniform
Allergies / Meds / Special Needs
4th Clubber Information
Child's Name (First, Middle, Last) Nickname Birth Date Gender
School Grade Need Book Need Uniform
Allergies / Meds / Special Needs
5th Clubber Information
*Child's Name (First, Middle, Last) Nickname Birth Date Gender
School Grade Need Book Need Uniform
Allergies / Meds / Special Needs

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