Katy Bible Church, Katy, Texas

Child Information
First name
Last name
Gender
Birthdate	/ /
Grade
Allergies (food, etc.)
Medical concerns

Club Placement	Age/grade as of 9/1/2010
Cubbies Sparks Truth and Training	3 & 4 years old K-2nd grade 3rd - 6th grade
Returning clubbers, list the handbook recently finished or working in:

Contact information
Street Address
City, State, Zip	,
Home phone
Email (for sending out monthly updates)

Parents/Guardians
Name
Work phone
Cell phone
Would you be willing to help out in our AWANA club?
Yes, by praying!
Yes, as a helper! Tell me how.
Yes, as a leader!	Club preference:

Emergency Contact	(if other than parent)
Name
Relationship
Phone