Awana Registration – Carlisle Baptist Church

Student Name: *


First	Last

Birthdate: *

	/		/
day		month		year

Grade: *

Special Instructions:

Parents/Guardians: *

Phone: *

-
Area Code	Phone Number

Alternate Phone:

-
Area Code	Phone Number

E-mail: *

Address: *

City/State/Zip: *

Child may also be picked up by:

If you have more children to register, please scroll down and continue rather than hitting "submit" now.

Student 2 Name:


First	Last

Student 2 Birthdate:

	/		/
day		month		year

Student 2 Grade:

Student 2 Instructions:

Student 3 Name:


First	Last

Student 3 Birthdate:

	/		/
day		month		year

Student 3 Grade:

Student 3 Instructions:

Student 4 Name:


First	Last

Student 4 Birthdate:

	/		/
day		month		year

Student 4 Grade:

Student 4 Instructions: