Evangelical Free Church of Columbia, Missouri

Child Information
Child Last Name	•
Child First Name	•
Child Date of Birth (must be before 8/1/04)	•
What grade will child begin in Spring 2009? Homeschoolers: Please pick grade based on Social Age, not academic ability	•	Kindergarten 1st grade 2nd grade 3rd grade 4th grade 5th grade
Name of School (If homeschooled, please write homeschool)	•
Has this child been in AWANA before?	•	Yes No
If yes, what was the last book this child worked in?	•
Did this child complete this book?	•	Yes No
If no, does this child need a new book?	•	Yes No
Please list any known allergies or special needs:	•
Mailing Address
Street Address Line 1	•
Street Address Line 2	•
City	•
State	•
ZIP Code	•
Parent/Guardian and Contact Info
Area in Awana where you'd like to serve:	•
Parent Last Name	•
Parent First Name	•
Relationship to Child	•
Contact Numbers: Where parent/guardian can be reached for information or emergencies
Home Phone Number	•
Cell Number	•
Home Church	•
E-Mail Address	•
What is the best way to reach you?	•	Phone Cell Phone E-Mail

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