AWANA Registration
Child's Information
First Name
*
Last Name
*
Date of Birth
*
School Grade
-- None --
2 & 3 year old
PreK 4/5
Kindergarten
1
2
3
4
5
6
7
8
9
10
11
12
Gender
Male
Female
Phone Number
Tip: Use numbers only; do not use any dashes (-) or spaces.
Email Address
*
Home Address
Home City
Home State
Home Zip Code
Health Information
Please provide any health concerns you believe we should be aware of.
Allergies
*
Special Needs
*
Additional Health Info
Emergency Contact Information
Contact Name
*
Contact Relationship
Contact Phone
*
Contact Name (2)
Contact Relationship (2)
Contact Phone (2)
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