Name

Birthday

Sex
MaleFemale

Address

City

State

Zip

Home Phone #

Parents Names

Cell Phones(s)

Email Address

Do you attend church?
YesNo

If yes what church?

Emergency Information (Person to contact if parents can not be reached)

Names

Relationship

Phone

Physicians Name

Physicians Phone

Medical conditions, allergies, special needs/instructions

Emergency Authorization
I hereby authorize the leaders of Awana's at NHBC to act on my behalf when I can not be contacted,
in case of an emergency, resulting in the need of medical attention for my son/daughter names above.
Type your name here to authorize

Club Enrollment (please indicate club and grade) (*Donations Accepted)

Puggles*Cubbies (Pre-K)*Sparks*KindergartenFirst GradeSecond GradeGirls Club*Boys Club*Third GradeFourth GradeFifth GradeSixth Grade

Books
PugglesCubbiesSparksBoys/Girls

Uniforms

Puggles shirt sizes
2T3T4T5T6T

Cubbies VestSparks Vest

Boys/Girls Green T-shirt (3rd & 4th Grade)
Child Size
YSYMYL
Adult Size
SmMed

Boys/Girls Blue T-shirt (5th & 6th Grade)
Child Size
YMYL
Adult Size
SmMedLrgXlgr

Blue Cubbies Hang Book BagSparks Hang Book BagT&T Sling Bag

Comment Area