AWANA begins September 13, 2016

You may register up to 3 children. If you need to register more than 3, complete form again.
Fields in bold are required.


Family Information

Family Name

Parent Name (or Guardian)

Address

Home Phone

Work Phone

Cell Phone

Email Address

Do you have a home church? NoYes If yes, where?


Child(ren) Information

Child 1 Child 2 Child 3

Name

Age

Grade

Birthday
/ /

Name

Age

Grade

Birthday
/ /

Name

Age

Grade

Birthday
/ /

Are there any special needs (e.g., allergies, behavioral, emotional, medical) that we need to be aware of? NoYes If yes, please describe.


Emergency Information

Please list names of any adults authorized to pick up your child from AWANA.

(in the event that the above parent/guardian cannot be reached)
Emergency Contact

Emergency Phone

[honeypot ok-719]

AWANA is from 6:30-8:00 PM.
You are responsible to pick up your child inside the building in a timely manner.
Your child will be released only to those who are listed on this registration.