Grace Bible Chapel - Awana Sign-Ups

First Adult Contact Person

Second Adult Contact Person

Phone Number (First Adult)

Phone Number (Second Adult)

Address

Apartment, suite, etc.

City

State

Zip/Postal Code

For Cubbies or Sparks, please list anyone besides the above adult(s) who is authorized to pick-up your child:

Please list the names, ages, and birthdate of the children you are registering.

Special concerns for leaders to be aware of such as health issues or food allergies:

I give permission for my child to be photographed and potentially appear in promotion material in the future:

Yes

No