Atlantic Baptist Church
Thursday, February 23, 2012
Calling people to live in Jesus, Coaching people to live like Jesus, Challenging people to live for Jesus.
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REGISTRATION FORM
2011-2012
Atlantic Baptist Church
 
NOTE: MUST ALSO COMPLETE MEDICAL RELEASE/PERMISSION FORM HERE
 
 
Child's Name
                                                  (First)                                                   (Last)
Address
 
City   Zip Code
 
Home Phone    Cell Phone
 
Birth Date   Age   Present Grade  
                               
Gender Male  Female
 
Parents/Guardian Names
 
Do You Attend Church Yes No  If so, where?
 
Would you like information about Atlantic Baptist Church?  Yes  No
 
E-mail address (optional)
 
Has your child previously been in AWANA?  Yes  No
 
Parent/Guardian Signature*
                                                     *MUST BE SIGNED IN PERSON
Security Code  (Choose a code of your choice.) (For use if someone else picks up your child.)