AWANA Pre-Registration Form

Please provide the following information about the child you are enrolling:

First name  
Last name  
Street address  
Address (cont.)  
City  
State  
Zip  
Date of Birth  
Home Phone  
Parent's Cell Phone  
Grade in School  

Is child involved in a church?  

  yes    no
If yes, name of church & city  
Name of Parents/Guardians
Person other than Parent or Guardian
who may pick up child after Awanas
Allergies or Medical Conditions we
need to know about?
Parent's E-mail Address   

Thank you for taking the time to provide this information.  We look forward to spending time with your child!