Awana Registration
Awana Registration 2017-2018
Clubber First Name: *
Your answer
Clubber Last Name: *
Your answer
Date of Birth: *
MM
/
DD
/
YYYY
Clubber is entering what grade level: *
My Clubber is a: *
Clubber Street Address: *
Your answer
Clubber City, State, & Zip: *
Your answer
Parent/Guardian Name: *
Your answer
Parent/Guardian Relationship to clubber: *
Your answer
Parent/Guardian Phone Number: *
Your answer
Parent/Guardian Email Address: *
Your answer
Emergency Contact Name: *
Parent will be contacted first.
Your answer
Emergency Contact Relationship to clubber: *
Your answer
Emergency Contact Phone Number: *
Your answer
School Clubber Attends: *
Your answer
Special Needs and/or Allergies: *
Required
Church: *
Required
Volunteering - I am interested in learning about the different roles that are available. *
Photo Release - I understand that River Valley Alliance has permission to use photos taken during Awana and Awana functions for promotional and production purposes. *
Required
Payment Plan (to be paid the first night of Awana) *
Thank you for participating in a Awana!
Checks can be made payable to "River Valley" with "Awana" on the memo line. Please bring payment to the first night of club.
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