AWANA Child Registration-Parkway Community Church
2017-2018
Child #1 Name
Your answer
Select program for Child #1
Allergies/Concerns/Issues for Child #1
Your answer
Child #2 Name
Your answer
Select Program for Child #2
Allergies/Concerns/Issues for Child #2
Your answer
Child #3 Name
Your answer
Select Program for Child #3
Allergies/Concerns/Issues for Child #3
Your answer
Child #4 Name
Your answer
Select Program for Child #4
Allergies/Concerns/Issues for Child #4
Your answer
Parent Name(s)
Your answer
Address
Your answer
Parent(s) Phone Numbers
Your answer
Parent(s) Email, please list both if applicable
Your answer
Does child reside with both parents? Explain if any custody issues or concerns
Your answer
Is there anyone who is NOT allowed to pick up your child?
Your answer
Church your family attends
Emergency Contact other than parents
(will use only if parents cannot be reached)
Your answer
Health Insurance Provider
Your answer
Policy #
Your answer
Preferred Hospital
Your answer
Payment Due
Method of Payment
Are your children interested in also signing up for kids choir? Practice will be prior to every night of Awana from 5:15-6pm.
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