AWANA Registration

Child's Information

Child's Name *
Grade *
Date of Birth *
Address *
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
Allergies & Additional Info *Enter 'none' if no allergies

Parent/Guardian Information

Parent/Guardian Name *
Parent/Guardian Phone *
Parent/Guardian Email *

Emergency Contact

Emergency Contact Name *
Emergency Phone *

Verification

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Copyright © Vandalia Baptist Church
3925 Pleasant Garden Rd.
Greensboro, NC 27406