Awana Registration Form

Please use this form to register your child for the 2011-2012 Awana year.

(If you have already filled out a registration form at the church, there is no need to register again.)

Child's name, address, and phone number:

Child's First Name

Child's Last Name

Street Address

City

State

Zip Code

Home Phone

Parent's e-mail address

Child's age and gender:

Age

Gender Male Female

Child's date of birth:

-- mm/dd/yy

Child's school grade:

Choose the appropriate Club for your child (age as of September 1, 2011):

Person to contact in an emergency:

First Name

Last Name

Home Phone

Child's allergies:

Any other information we need to know about the child (medical conditions, etc.)

Father's name (or Legal Guardian)

Mother's name (or Legal Guardian)

This site was last updated 08/13/11