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Christ The Healer Church
The Place Where Change Happens
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Gwendolyn Yvette Brooks-Richardson
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ABOUT
The Church
Ministries
Leadership
Bishop Calvin Lockett
Pastor Lynnita Lockett
Gwendolyn Yvette Brooks-Richardson
New to CTH
Awana Registration Form
Please Fill Out Form Below or Download Form For Later
Click Here To Download Awana Registration Form
Awana Enrollment Form
Student Information
Name
*
First
Last
Uniform
Vest
Shirt
Size
Gender
*
Male
Female
Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Home Phone
*
Date of Birth
*
AGE
*
Please enter a value less than or equal to
30
.
Grade
Parent / Gaurdian Information
Child Lives With:
Mom
Dad
Both
Mother's Name
First
Last
Work Phone
Cell Phone
Email
Father's Name
First
Last
Work Phone
Cell Phone
Email
Emergency Contact Information
Name
First
Last
Relationship
Work Phone
Cell Phone
Email
Any Special Concerns?
Pick Up By
Physician Name
First
Last
Office Phone
Type of Insurance
Policy Number
Registration Fee
*
New Student
Returning Student
Total
$0.00
Check All That Apply
I am paying my child’s registration in full.
I would like to pay my child’s registration in increments
I am giving beyond the registration required for my child
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