Creekside Youth Registration Form
Use this form to register your child for AWANA in the 2021-2022 school year. Please fill out the form for one child at a time.
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Email *
What is the Child's name? *
What Club will the child be a part of? *
What is the Child's address? *
How old is the Child? *
What is the Child's birthdate? *
MM
/
DD
/
YYYY
What grade is your child in during the 2021-2022 school year? *
Please input your answer with the number of the grade only. ie "1" for first grade or "11" for eleventh grade. Please DO NOT input text only answers such as "First" or hybrid answers such as "1st".
What gender is your child? *
What School does your child attend? *
Example: Carlisle Elementary School
Has your child been to AWANA prior to this year? *
Does your child have a handbook? *
What is the father's name (if applicable)? *
What is the mother's name (if applicable)? *
What is the guardian's name (if applicable)?
What is the address of the parent/guardian (if different from the child's)?
What is the Father's cell phone number? *
Provide cell phone number of the father. If this is not applicable type "NA". Example: 515-123-4567
What is the Mother's cell phone number? *
Provide cell phone number of the Mother. If this is not applicable type "NA". Example: 515-123-4567
What is the Guardian's cell phone number?
Provide cell phone number of the Guardian. If this is not applicable type "NA". Example: 515-123-4567
What is the Father's email address? *
If this is not applicable type "NA". Example: johndoe@gmail.com
What is the Mother's email address? *
If this is not applicable type "NA". Example: johndoe@gmail.com
What is the Guardian's email address? *
If this is not applicable type "NA". Example: johndoe@gmail.com
Who will bring the child to and pick them up from AWANA when in person meetings resume?
Select the party who will be responsible for picking up and dropping off the child from AWANA.
Clear selection
Please list any allergies, medical conditions, or activity limitations your child has:
Provide additional comments.
Example: Do not give child candy.
Submit
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