Vicksburg Bible Church AWANA Registration for 2018-2019 School Year
Kindly use drop down menus, check boxes and tabs to input your data. Select "SUBMIT" when you are finished. Your registration will be complete when you sign the liability waiver at the first AWANA meeting Tuesday September 11th, 2018.
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Email *
Family Last Name *
Best Family Phone Number (ie. 269-123-4567) *
Mother's Last Name (If different than child)
Mother's First Name
Mother's Cell Phone Number (ie. 269-123-4567)
Father's Last Name (If different than child)
Father's First Name
Father's Cell Phone Number (ie. 269-123-4567)
Street Address *
City *
Zip Code *
Mailing Address (If different than above)
Emergency Contact (Name - Relationship) *
Emergency Contact Phone Number (Please Note if home or cell number) *
The following persons have permission to pick up my child(ren) from AWANA:  (Name/ Cell Phone Number)
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