AWANA REGISTRATION

Mom's Full Name

Mom's Email

This address will receive a confirmation email

Mom's Cell Phone

Dad's Full Name

Dad's Email

This address will receive a confirmation email

Dad's Cell Phone

Home Street Address

CHILD 1 REGISTRATION

Child's Full Name

Child's Full Birthdate

Child's Grade

Any allergies or medical information we need to know about:

CHILD 2 REGISTRATION

Child's Full Name

Child's Full Birthdate

Child's Grade

Any allergies or medical information we need to know about:

CHILD 3 REGISTRATION

Child's Full Name

Child's Full Birthdate

Child's Grade

Any allergies or medical information we need to know about:

Contact on the night of Awana:

Contact Name

Contact Phone

Permissions

In the event of an emergency in which my child is in need of immediate medical attention, hospitalization or surgery, and after reasonable efforts have been made to contact me (parents or guardian) and we can not be located, consent for the emergency attention may be given City Church Awana leadership.

I understand that during Awana my child may be videotaped or photographed. By signing this form I am giving permission for my child to appear in photos or videotape in City Church services or promotional materials.

I agree to both of the above:

Yes No

PAYMENT

Please choose payment options:

Description

Please complete this form for Awana Registration. Click SUBMIT when finished.

AWANA REGISTRATION

Description

Please Fix the Following