Registration

* Indicates required field

Parent/Guardian Name *

First

Last

Email *

Phone Number *

Emergency Contact *

Phone Number *

Child's Name 1 *

First

Last

Age *

Current Grade *

Child's Name 2 *

First

Last

Age *

Current Grade *

Child's Name 3 *

First

Last

Age *

Current Grade *

Child's Name 4 *

First

Last

Age *

Current Grade *

Any food allergies/medical information that we may need to know? *

If you have a child with special needs, would you like a buddy? *

May we have permission to take and use your child's photograph for any church publications? *

Yes No

Who is allowed to pick up your child at dismissal at the end of each Awana night? *

Do you have a local church home? If so, what church? *

Submit