AWANA Registration Form

KID'S CLUB REGISTRATION FORM

Childs Name (required)

Age (required)

Grade

Gender (required)
MaleFemale

Parents Name (required)

Phone (required)

Address (required)

City (required)

State (required)

Zip (required)

Email

Emergency Contact Name & # (required)

MEDICAL INFORMATION

Medical Conditions

Medical Insurance

Doctor's Name

Practice Name

Phone Number

Group #

Childs ID #

Primary Members Name

Registration forms due 1 week before AWANA begins.

In case of medical emergency, I understand every effort will be made to contact parents or guardian of participant. In the event I cannot be reached, I hereby give permission to the physician selected by the church staff to secure proper treatment for my child.

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