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Registration Fall 2009

Child’s Name:
Address:
City, St, Zip:
Phone:
Birthday: Grade:
Parent/Guardian:

Please indicate which AWANA club your


child will attend in September 2009

3 and 4 year olds

Kindergarten through 2nd grade

3rd/4th grade girls

5th/6th grade girls

3rd through 6th grade boys

Please fax this form to 573-335-8807 or mail to


Bethany Baptist Church
1712 Randol Ave
Cape Girardeau, MO 63701

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