Awana Registration

Clubber Name: *   E-mail: *

Address: *   Address2: *

City: *   State: *  Zip Code: *

Phone: *

Childs Birthdate: *   School grade completed: *

Parent(s) Name: *  Parent(s) Work Number:

Emergency Contact: *   Emergency Number: *

Allergies or other medical conditions:

Home Church (if any):

Individuals Authorized to Pick Up Child (other than parents):

*One friend I'd like to be teamed up with (not a guaratee):

By checking this box, parent/guardian authorizes Awana leaders to contact the cubber registered herein through written correspondence such as "Get Well" cards or Birthday cards and to call by telephone to discuss club activities.