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AWANA Registration - Northbridge
Registration Fee
AWANA Registration Fee $20.00/child with $40.00/family maximum
How did you find out about our AWANA program? *
Child's First Name *
Your answer
Child's Last Name *
Your answer
Child's Gender *
Birthdate (format as MM/DD/YYYY) *
Your answer
Age (on September 1) *
Grade (current school year) *
Allergies or Medical Conditions (we should know about) *
Your answer
Additional Information (special considerations or requests)
Your answer
Street Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Parent/Guardian Name *
Your answer
Phone Number *
Your answer
Phone Type *
Email Address *
Your answer
Home Church (Child's family attends)
Your answer
Emergency Contact Person *
Your answer
Emergency Contact Phone Number *
Your answer
Emergency Contact Relationship *
Your answer
Personnel authorized to pick-up child from AWANA *
Your answer
Other Family Members' Names (Participating in AWANA or associated with Northbridge)
Your answer
I give permission for basic first aid to be administered to my child in the event of an injury/incident. It is my understanding that parents will be notified of any and all injuries and contacted immediately in an emergency situation. *
When Northbridge AWANA events are postponed or cancelled, I prefer to be contacted by: *
E-mail is an acceptable method to contact me with general AWANA information. *
[From time to time, Northbridge AWANA produces videos and pictorial slideshows for promotion of the club that may, or may not be used on the internet.] I give permission for my child to be photographed or videotaped for use in such promotions. *
[From time to time, Northbridge AWANA leaders like to communicate with the children with a card to cultivate the relationship and say - "Hello", "Enjoy having You in the Club", "Happy Birthday", "Get Well", or "Missing You". AWANA Leaders would like permission to contact your child through this method of correspondence.] I give permission to contact my child through the communication described. *
Name of the Person (First + Last) completing this Registration *
Your answer
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