AWANA form

AWANA Registration Form

* Indicates required field

Clubber's Name *

First

Last

Birthdate *

Age *

Medical Conditions or Allergies *

Grade in School *

Clubber #2 (if more than one child) *

First

Last

Medical Conditions or Allergies ( Clubber #2) *

Birthdate *

Age *

Grade in School *

Clubber #3 (if more than two children) *

First

Last

Clubber #3 Medical Conditions or Allergies *

Birthdate *

Age *

Grade in School *

Physical Address *

Mailing Address if Different From Physical Address *

Parent/Guardian(s) *

E-mail address (Parent or Guardian) *

Home Phone *

Cell Phone *

Church *

Individuals authorized to pick up child from club *

Parent Signature *

Authorization of Typed Signature

By typing my name to the signature line, I confirm that I am the parent of the child (children) listed above and I wish to enroll them in the AWANA program at Reynolds Baptist Church

Submit