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