First United Methodist Church – Picayune, Mississippi
Clubber Registration/Information Form
Amount Rcd____________Ck #___________By__________Date Completed____________
|
Annual Fee $35.00
Weekly Dues $0.50
|
| SHIRT SIZE: |
Club Placement
| Puggles- 1 - 2 year olds | T & T (3rd – 6th Grade) |
| Cubbies - 3 & 4 year olds (must be 3 years by 9/1/10) | Trek (Jr. Youth) |
| Sparks - Kindergarten (must be 5 years by 9/1/10) – 2nd Grade | Journey (Sr. Youth) |
Child's Name Birth Date Age Grade
Home Phone: E-Mail:
Home Address:
School Child Attends: Sex: Male Female
Church that you regularly attend: I am a member First United Methodist Church
Other - None
Mother’s Name
E-Mail Address:Telephone (H) (W) (C) (Pager)
Address(If Different from child)
Church that you regularly attend (if different than child):
Other - I am a member None
I would like a visit to learn more about Awana ministries at First United Methodist YES NO
I may be interested in serving in Awana ministries at First United Methodist YES NO
Father's Name
E-Mail Address:
Telephone (H) (W) (C) (Pager)
Address(If Different from child)
Church that you regularly attend (if different than child):
Other - I am a member None
I would like a visit to learn more about Awana ministries at First United Methodist YES NO
I may be interested in serving in Awana ministries at First United Methodist YES NO
Siblings Names and Ages:
List other people that are authorized to pick up your child from activities sponsored by First United Methodist Awana:
Name
Relationship to Child
Address
Name
Relationship to Child
Address
When parents cannot be reached, list at least one person who may be contacted to pick up the child in an emergency:
1. Name
Telephone (H) (W)(C) (Pager)
Address
2. Name
Telephone (H)(W) (C)(Pager)
Address
Parent Signature _____________________________________________________________________ Date ____________________
Clubber Registration/Information Form