Awana Registration

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Awana
REGISTRATION

Child's First Name

Child's Last Name

Parent/Guardian

Address

Phone

Email

Birth Date

Last grade completed

Medical information/allegies?

EMERGENCY CONTACT

Thanks for registering to our event. See you there!

6361 Pony Express Trail

PO Box 59

Pollock Pines, CA 95726

530-644-2133

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