AWANA Registration

2007-2008

First Baptist Church

3550 Fox Meadow Rd., Eugene, OR  97408

345-0341      awana@fbceugene.com

 

Parent/Guardian Name______________________  Home Phone____________  Cell____________

 

Address__________________________________  City_________________  Zip Code__________

 

E-mail___________________________________  Home Church____________________________

 

Where can you be reached during club?_________________________________________________

 

 

Child 1____________________________________________________________  M_____  F_____

           

            Club__________________________________  Birthdate____________  Year in school_____

                 (Cubbies: 3-4 yrs.; Sparks: K-2nd gr.; T&T: 3rd-6th gr.)

 

            Food allergies or asthma_______________________________________________________

 

Child 2____________________________________________________________  M_____  F_____

           

            Club__________________________________  Birthdate____________  Year in school_____

           

            Food allergies or asthma_______________________________________________________

 

Child 3____________________________________________________________  M_____  F_____

           

            Club__________________________________  Birthdate____________  Year in school_____

           

            Food allergies or asthma_______________________________________________________

 

Child 4____________________________________________________________  M_____  F_____

           

            Club_________________________________  Birthdate ____________  Year in school_____

           

            Food allergies or asthma_______________________________________________________

 

Child 5____________________________________________________________  M_____  F_____

           

            Club_________________________________  Birthdate ____________  Year in school_____

                       

            Food allergies or asthma_______________________________________________________

 

 

Dues:  $30.00 per child

Make checks payable to:  First Baptist Church

 

AWANA office use only

 

Parent leader?____________  Medical Release Form for each child?____________                              AW_____ 

              

Total dues____________  Ck. No._______  Cash______  Payment__________  Date__________ Balance_________ Payment__________  Date_________  Balance_________ Payment__________Date__________  Balance_________