2019 Awana Registration
Registration for 2019-2020 Awana year!
Email *
Child's Name *
Grade Completed *
Birthday *
MM
/
DD
/
YYYY
Parent/Guardian Name *
Home Address *
Home Phone *
Alternate Phone *
Emergency Contact *
Emergency Contact Phone *
Relationship to Child *
Food Allergies *
Required
If "YES" to food allergies, please list
Medical Concerns *
Required
If "YES" to medical concerns, please list
Family Doctor *
Family Doctor Phone *
Are you a Member of a Church? *
If "YES" to being a member of a Church, please list the name of the Church:
Person 1 who can pick up your child (Name and Phone) *
Person 2 who can pick up your child (Name and Phone)
By Checking the box below, you are agreeing to permission for your child/children named above to be photographed/filmed for any lawful purpose associated with this Awana Program *
Required
Signature
Typing your name below constitutes your lawful signature that all information above is correct
Submit
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