Awana Registration 2023-2024

Student Name

Sex

Male Female

Student's Birthdate

Parents/Guardians Name

This address will receive a confirmation email

Phone

Address

Age Group

Cubbies - age 3-Preschool Sparks - K-2nd grade T&T - 3rd-6th grade Trek - 7th-8th Journey - 9th-12th

T-shirt size

Youth Small Youth Medium Youth Large Youth X-Large Youth XX-Large Adult Small Adult Medium Adult Large Adult X-Large

Payment

May we have permission to photograph your child?

Yes No

May we use your child's photograph for promotional purposes for Awana?

Yes No

Home Church (if any)

Alternate contact's name

Alternate contact's phone number

Individuals authorized to pick up the student

Students doctor/contact number

Tetanus current (7 years)

Yes No

Specific allergies, illnesses or other conditions?

To whom it may concern: As a parent and/or legal guardian, I do hereby authorize the treatment by a qualified and licensed medical doctor of the above minor in the event of a medical emergency which, in the opinion of the attending physician, may endanger his or her life, and/or cause disfigurement, physical impairment, or undue discomfort if delayed. This authority is granted only after a reasonable effort has been made to contact me. This release form is completed and signed of my own free will with the sole purpose of authorizing medical treatment under emergency circumstances in my absence. By checking yes in the box provided, I am giving medical consent for my child to be treated if needed.

Yes

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Awana Registration 2023-2024

Description

Please Fix the Following