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AWANA Registration/Consent Form
Wednesdays September 25-April 30, 6:00-7:30 p.m.
North Avenue Church of God, 1079 North Avenue, Battle Creek, MI 49017
Cost: $15 (includes book and other resources)
Contact us at (269) 965-1908 or
info@northavenuechurch.com
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* Indicates required question
Child's Name
*
Your answer
Birthdate
*
MM
/
DD
/
YYYY
Street Address
*
Your answer
City
*
Your answer
State
*
Your answer
ZIP
*
Your answer
Phone
*
Your answer
Can receive text messages
*
yes
No
Email address
*
Your answer
Parent name(s)
*
Your answer
Pickup name (if other than parent)
Your answer
Anyone who should NOT pick up your child
Your answer
Emergency Contact name
*
Your answer
Emergency Contact phone
*
Your answer
Allergies or other medical conditions
Your answer
School grade entering
*
None/Preschool
Kindergarten
1st
2nd
3rd
4th
5th
Name of home church (if any)
Your answer
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