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New Awana Registration
Household Information
Parent/Guardian #1
*
Relationship
Dad
Grandparent
Guardian
Mom
Parents
Parent/Guardian #2
Relationship
Dad
Grandparent
Guardian
Mom
Parents
Address
*
City
*
State
*
Zip
*
Enter alternate address for Parent/Guardian#2
Phone#
*
Address
City
State
Zip
Phone#
Other Emergency Contacts (include phone numbers)
Please include a phone# and name for each of your Other Emergency Contacts.
List others authorized to pickup your child
What church do you attend?
Church attendance is NOT required. Enter NONE if you don't attend a church.
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I don't have an email address
Email
*
Alternate Email
New password
*
Please enter a password you'd like to use to login to this site.
Clubber Information
First Name
*
Last Name
*
Gender
*
Please select...
Boy
Girl
Grade for 2024-25
*
Please select...
Pre-School (Cubbies)
Kindergarten (Sparks)
Grade 1 (Sparks)
Grade 2 (Sparks)
Grade 3 (T&T)
Grade 4 (T&T)
Grade 5 (T&T)
Grade 6 (T&T)
Birthdate
*
Month...
January
February
March
April
May
June
July
August
September
October
November
December
Invited by
Special Notes
Please enter any special notes that we should know about your child. For example, allergies, special instructions, etc.
Medical Release:
As a parent/guardian, I give my permission for the above minor to attend Awana activities including regular club nights and any special activities from September 2024 to May 2025. I authorize treatment under the direction of any licensed physician of the above minor in the event of a medical emergency which in the opinion of the attending physician my endanger his or her life, cause disfigurement, physical impairment or undue discomfort if delayed. This authority is granted after reasonable effort has been made to reach me by phone. I will not hold the church, or their staff, administration, or workers, liable for any injury to or loss of possessions by the above minor during any activity either on the church property or away, including regular meetings as well as special events.
YES
, I give permission as stated above for my child regarding medical care
NO
, I do
NOT
give permission for my child to receive medical care
In lieu of your signature, please enter your initials:
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Devon Clark
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