Foxworthy Baptist Church
AWANA Registration for 2011-2012

AWANA is for children age 3 (by October 1, 2011) up to those entering 6th grade this year.

Please enter information about your family.

Parent/Guardian name(s)
Street address:
PO Box or Apt. Number
City, State, Zip
Email address
Phone number
Work Phone number
Cell Phone number
In emergency, who do we contact and what is their relationship to the child(ren)?
Emergency contact's phone
Please list any other adults you authorize to pick up the child(ren)
Home church, if any
Additional comments
Please enter information about each child being registered.
1.
First Name	Last Name Birth Date
Medical or other info we need to know
	Age Grade
2.
First Name	Last Name Birth Date
Medical or other info we need to know
	Age Grade
3.
First Name	Last Name Birth Date
Medical or other info we need to know
	Age Grade
4.
First Name	Last Name Birth Date
Medical or other info we need to know
	Age Grade

E-mail confirmation of registration
Phone confirmation of registration

To finalize your registration, press this button:

If you would like to start over without submitting request:

Foxworthy Baptist Church * 1774 Foxworthy Avenue * San Jose, CA 9512 * (408)269-1212 * FAX (408) 269-1213