AWANA Registration

Child Last Name *

Child Current Grade/Group on first day of AWANA Club 2022 - 2023 *

Child First Name *

Child Current Age *

Child's Sex *

Child Date of Birth *

Child Address *

Street Address

City

State

Zip Code

Does Child Have Allergies?

No
Yes

Allergies Information *

Does Child Have Any Medical Concerns?

No
Yes

Medical Concerns Information *

Restroom Information *

Potty Trained

Child must be potty-trained to attend AWANA Club

Parent/Guardian Last Name *

Parent/Guardian Cell Phone *

Parent/Guardian First Name *

Parent/Guardian Email *

Email

Confirm Email

Parent/Guardian Relationship To Child *

Is Parent/Guardian's Address the Same a Child's Address? *

Yes
No

Parent/Guardian Address *

Street Address

City

State

Zip Code

Additional Parent Or Guardian To Be Listed *

Yes
No

Additional Parent/Guardian

#2 Parent/Guardian Last Name *

#2 Parent/Guardian Cell Phone *

#2 Parent/Guardian First Name *

#2 Parent/Guardian Email *

#2 Parent/Guardian Relationship to Child *

Is #2 Parent/Guardian's Address the Same a Child's Address? *

Yes
No

#2 Parent/Guardian Address *

Street Address

City

State

Zip Code

Emergency Contact Last Name *

Emergency Contact First Name *

Emergency Contact Relationship To Child *

Emergency Contact Cell Phone *

Medical Release *

Liability *

Use of Pictures for Promotional Material *

Parent/Guardian Signature *

By submitting this form, you agree to the above Medical Release, Liability, Use of Pictures for Promotional Material. If you have questions or concerns please contact the Church Office BEFORE submitting this form.

AWANA Registration

2022-2023 Registration Beginning August 2022

Additional Parent/Guardian

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AWANA Registration

2022-2023 Registration Beginning August 2022

Additional Parent/Guardian

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