Emmanuel Baptist Church - Macclenny, FL

AWANA Registration

Register for AWANA

Child's First Name:

Child's Last Name:

Child's Date of Birth:

Gender:

Grade:

Allergies and Restrictions:

2nd Child's First Name:

2nd Child's Last Name:

2nd Child's Date of Birth

Gender

Grade

Allergies and Restrictions:

3rd Child's First Name:

3rd Child's Last Name:

3rd Child's Date of Birth

Gender

Grade

Allergies and Restrictions:

4th Child's First Name:

4th Child's Last Name:

4th Child's Date of Birth

Gender

Grade

Allergies and Restrictions:

5th Child's First Name:

5th Child's Last Name:

5th Child's Date of Birth

Gender

Grade

Allergies and Restrictions:

Parent's / Guardian's Names:

Address

City:

State:

ZIP:

Phone:

Email:

Home Church:

Photo Release

I understand that as a participant, I or my child may be photographed or videotaped during normal AWANA activities, and these photos/videos may be used for promotional purposes.

I Agree

Yes, I agree

1st Emergency Contact Name:

1st Emergency Contact Phone:

2nd Emergency Contact Name:

2nd Emergency Contact Phone:

Names of other individuals who may pick up your child:

LOCATION

12286 North County Rd. 23a

Macclenny, FL 32063

SERVICE TIMES

Sunday at 11:00am

Wednesday at 7:00pm

CONTACT US

(904) 259-1676

info@ebclife.org