AWANA Registration Form

Child's Name *

Parent/Guardian Name *

Address *

Mailing Addess (if different)

Cell Phone

Home Phone

Work Phone

Birth Date *

Grade *

Medical Information

Emergency Contact Name *

Emergency Contact Phone *

Backup Emergency Contact Name

Backup Emergency Contact Phone

Person(s) Allowed to pick up child *

Church Attendance

HHBC Host

OK to photograph *

Yes

OK to publish photograph *

Yes

You can enter multiple children by clicking on the "Add Another Person" button below.

BE SURE TO CLICK ON "SUBMIT" button after all children have been entered!