Child Parent/Guardian Safety Help Us? Complete

Step 1 of 5 Required fields are in red and indicated by an (*). NOTE: phone numbers must be entered with numbers only (eg 6105551212). * Child's Name * Child's DOB January February March April May June July August September October November December 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30   1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 Your child will be assigned to a group based their age as of 09/01/2008.   One friend your child would like to be grouped with:   (child should be the same age. We will do our best to fulfill all requests.)   Allergies or Other Conerns:

Questions about Bethany's Awana program or this form? Please email us!