AWANA Registration

Name: 

Date of Birth:   Age:   Grade: 

Club: Cubbies(3 yr -K4)  Sparks(K5-Grade 2)   T & T(Grade 3-Grade 5)

                            (Children must be 3 years old by September 1, 2010)    

Allergies/Medical Conditions:    

          Parent Name: 

          Address: 

          City:   State:  Zip: 

          Home Phone:   Cell Phone: 

          E-Mail Address: 

          Where do you attend church? 

May we have permission to photograph your child? Yes  No

May we use your child's photograph in church publications for the purpose of  promotion?  Yes  No

I am willing to serve as a Listener every week from 7:00 pm-7:30 pm.              Yes  No

I am willing to serve as a Listener at least one Wednesday night per month from
7:00 pm-7:30 pm. Yes  No

I am interested in helping in other areas. Yes  No