Awana Registration

Clubber Information

Childs Name:



Child's Gender:

Date of Birth:

Child's Age:

Last School Grade Completed:

Home Church:

Father/Mother/Gaurdian: Phone:
Father/Mother/Gaurdian: Phone:
Brought to Awana by: Phone:
Emergency Contact: Phone:

Medical Information

Chronic Illness:

Allergic Reactions:

Medication Taken on Regular Basis:

Physician: Phone:

Activity Permit

As a parent and/or guardian, I do herewith give permission for my child to participate in AWANA events or activities. I further give permission for AWANA adult leaders to seek appropriate medical attention in the event of a medical emergnecy. I fully understand that every effort will be made to contact me.
I Agree