10 Romans Road, Hyde Park, NY 12538     *     (845) 229-9150     *     Fax: (845) 229-1074     Contact Us

   

AWANA Program
Registration Form
Child's Name:
Child's Age:
Grade (Going Into):
Address:
City, State, Zip:
Home Telephone#:
Mother's Name:
Father's Name:
Emergency Contact Name:
Emergency Contact Telephone #:
Allergies or other medical conditions:
Home Church:
Guest of:
Additional Comments:

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All rights reserved.
Revised: 01/11/12