Camarillo Community Church | 1322 Las Posas Drive | Camarillo, CA 93010

Registration Form

Kind

NEW registration	address/phone change
name change	family member change

my child/children also attends:

Women's Bible Study (name)

M.O.P.S. (day)

other Awana

home information:

home phone (with area code)

primary email

head of household :

first middle last

goes by (name printed on tag)

date of birth (mm/dd/yy) gender M F

home address

city zip

cell phone work phone

spouse :

first middle last

goes by (name printed on tag)

date of birth (mm/dd/yy) gender M F

home address

city zip

cell phone work phone

child 1 information :

first middle last

goes by (full name printed on tag)

date of birth (mm/dd/yy) gender M F

grade school

allergies

print allergy info on nametag keep confidential

special needs/medical information

print special need/med info on nametag keep confidential

child 2 information :

first middle last

goes by (full name printed on tag)

date of birth (mm/dd/yy) gender M F

grade school

allergies

print allergy info on nametag keep confidential

special needs/medical information

print special needs/med info on nametag keep confidential

child 3 information :

first middle last

goes by (full name printed on tag)

date of birth (mm/dd/yy) gender M F

grade school

allergies

print allergy info on nametag keep confidential

special needs/medical information

print special needs/med info on nametag keep confidential

child 4 information :

first middle last

goes by (full name printed on tag)

date of birth (mm/dd/yy) gender M F

grade school

allergies

print allergy info on nametag keep confidential

special needs/medical information

print special needs/med info on nametag keep confidential

Comments:

Children's Ministry

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