Child #1: Date of Birth *

MM

DD

YYYY

Child #1: Gender

Male

Female

Child #1: Grade in the Fall of 2024

Pre-K or younger

Kindergarten

1st Grade

2nd Grade

3rd Grade

4th Grade

5th Grade

6th Grade

Is this the child's first year in Awana?

Yes

No

Does the child have any medical/allergy concerns or disabilities/special needs we need to know about? *

Yes

No

Child #2: Date of Birth:

MM

DD

YYYY

Child #2: Gender

Male

Female

Child #2: Grade in the Fall of 2024

Pre-K or younger

Kindergarten

1st Grade

2nd Grade

3rd Grade

4th Grade

5th Grade

6th Grade

Is this the child's first year in Awana?

Yes

No

Does child #2 have any medical/allergy concerns or disabilities/special needs we need to know about?

Yes

No

Child #3 Date of Birth

MM

DD

YYYY

Child #3 Gender

Male

Female

Child #3: Grade in the Fall of 2024

Pre-K or younger

Kindergarten

1st Grade

2nd Grade

3rd Grade

4th Grade

5th Grade

6th Grade

Is this child #3's first year in Awana?

Yes

No

Does child #3 have any medical/allergy concerns or disabilities/special needs we need to know about?

Yes

No

Phone Number *

(###)

###

####

Text Alerts *

Would you like to sign up for text alerts for reminders or last-minute changes? These are a simple weekly group text (sent on Friday) from the Director that remind you of the Awana night and what is happening that night (regular club night or pajama night or other fun night).

Yes

No

Parent/Guardian #2 Phone (optional)

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Emergency Contact Phone Number *

(###)

###

####

MEDICAL RELEASE: As a parent/guardian, I give my permission for the registered minor to attend Awana activities. I authorize treatment under the direction of any licensed physician of the registered minor in the event of a medical emergency which in the opinion of the attending physician may endanger his or her life or cause disfigurement, physical impairment or 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 volunteers, liable for any injury to or loss of possessions by the registered minor during any activity on the church property. *

YES, I give permission as stated above for my child(ren) regarding medical care

NO, I do NOT give permission for my child(ren) to receive medical care