Tri-Lakes Chapel Awana Registration

Please fill out a separate registration form for each child.

The BOLDFACED items are required.

Date: 9/5/2010 Name Birth Date Age Grade 10/11 Parent's Names Address Zip Phone Number Parents Email Address Emergency Contact Emergency Contact Relationship Emergency Contact Phone Allergy/Health Info/Meds/Special Needs? Other person authorized to pick up child Has your child made a profession of faith in Jesus Christ? Yes No Unknown Family's Home Church Payment Method On-Line Check Cash Check Number/Amount Learn more about our Privacy Policy here.