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AWANA Registration
Child's Name (First and Last)
Birthdate (mm/dd/yyyy)
Grade in School
Home Phone #
School Child Attends
Child's Home Address (Street, City, State, ZIP)
Parent(s) Names
Parent E-mail Address
Parent Home Phone #
Parent Work Phone #
Parent Cell Phone #
Church You Attend Regularly
Up to 2 other adults who can pick your child up.
List any important medical information
I give BBC permission to seek medical attention for my child in the event of an emergency
I release BBC and its volunteers from responsibility for any injuries suffered in relation to any aspect of an Awana club night.