CHBC Student Registration

AWANA Registration

Cheatham Hill Baptist Church
Asterisk "*" indicates required field.
Student Full Name*

First NameLast Name
Student Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Home Phone*

Area CodePhone Number
Additional Phone

Area CodePhone Number
School Grade*
Does Student Attend Church?

YESNO
Permission to Photograph Student?*

YESNO
Student Birth Date (MM-DD-YYYY)*
Parent or Guardian Full Name*

First NameLast Name
Relationship to Student
Parent/Guardian Email
Authorized Person to Pickup Student*

First NameLast Name
Authorized Person to Pickup Student

First NameLast Name
Authorized Person to Pickup Student

First NameLast Name
Emergency Contact Full Name*

First NameLast Name
Emergency Contact Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Emergency Contact Phone*

Area CodePhone Number
Emergency Contact - Alternate Phone

Area CodePhone Number
Student's Medical Issues*
Prescribed Meds (Please List)*
Allergies*
To Show You're Not an Internet Robot, Please Enter the Message as Shown*
Should be Empty: