AWANA Clubs

Blue

Clubber Registration

 

AWANA clubs begin September 14, 2016

Wednesday's from 6 p.m. - 7:30 p.m.!

Thank you for beginning the registration process by filling out this electronic form. We will also need you to sign the registration form that will be available in your child's Club room the first night you attend clubs.

*required information (if required info does not apply, type "none")

Parent Full Name: *
First Name
Middle
Last Name
Address: *
Address Line 1
Address Line 2
City
State/Prov.
Postal Code
Home Church:*
Persons (other than parents) authorized to pick up the children: *

Contact Information

Home Phone:*
Work Phone:*
Cell Phone:*
Emergency Phone:*
Email:*
Other:*

Family Information

Doctor Name/Phone: *
Dentist Name/Phone: *
Child #1 *
First Name
Middle
Last Name
Nickname:
Birth Date:*
Gender: *
Grade*
Allergies/Meds/Special Needs: *
Child #2:
First Name
Middle
Last Name
Nickname:
Birth Date:
Gender:
Grade:
Allergies/Meds/Special Needs:
Child #3:
First Name
Middle
Last Name
Nickname:
Birth Date:
Gender:
Grade:
Allergies/Meds/Special Needs
Child #4
First Name
Middle
Last Name
Nickname:
Birth Date:
Gender:
Grade:
Allergies/Meds/Special Needs:
Child #5:
First Name
Middle
Last Name
Nickname:
Birth Date:
Gender:
Grade:
Allergies/Meds/Special Needs