AWANA Registration 2025-2026
Please complete a separate form with all information for each child you are registering (even for those in the same family).
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Child's First Name *
Child's Last Name *
Child's Gender *
Child's Date of Birth *
(MM/DD/YYYY)
Grade or Age Group *
Please describe any allergies or medical conditions we need to be aware of
Parent/Guardian First and Last Name(s) *
Parent/Guardian Street Address *
Parent/Guardian City, State, Zip Code *
Parent/Guardian Phone Number *
(xxx-xxx-xxxx)
Parent/Guardian Email Address *
Emergency Contact Name *
Emergency Contact Phone Number *
Emergency Contact Relationship to Child
Name of church where you are currently involved (if any)
As a parent and/or guardian, I do herewith authorize the treatment by qualified and licensed medical doctor of the above named participant in the event of a medical emergency which, in the opinion of the attending physician, may endanger his/her life, cause disfigurement, physical impairment or undue discomfort if delayed.  This authority is granted only after a reasonable effort has been made to reach me. This release will be in effect on the date(s) starting September 1, 2025 and continuing until May 30, 2026.  My agreement also serves to indicate my willingness to take full financial responsibility for any and all medical services rendered for the above named participant.  My agreement also serves to indicate my willingness for my insurance company to be billed for any and all medical fees and services should they be needed and to release AWANA Clubs International, its employees, and its charters from this liability. *
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