CrossRoads Baptist Church - Ministries

AWANA Registration

*Name:


First Name	Last

*Date of Birth:

*Age:

*Gender:

*Address:

Apt #:

*City:

*State:

*Zip:

*Primary Phone:

format : XXX-XXX-XXXX

Secondary Phone:

format : XXX-XXX-XXXX

*Email Address:

*Name of Home Church:

*Grade:

*Name of Parent/Guardian:


First Name	Last

Name of a Parent/Guardian/Friend who will pick the child up:


First Name	Last	Relation

*Does the child need a uniform:

*Uniform Size (If Needed):

*Does the child need an AWANA book:

CrossRoads Baptist Church · 1851 S. Clyde Morris Blvd. · Daytona Beach, FL 32119 · Contact Us
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