Awana Registration Form 
Registration is open until August 20th. All children MUST be registered to participate in AWANA 2023-2024. Please fill out a registration form per child you have attending AWANA.
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Child's Full Name *
What size does your child wear? *
We recommend sizing UP since your child will wear it for multiple AWANA years! 
Gender *
Age  *
as of Sept 1st, 2023
Grade in School *
as of Sept 1st, 2023
Birthdate *
MM
/
DD
/
YYYY
Parent's First and Last Name *
Names will be printed next to registration form signature line and will be needed for signing in and signing out. 
Street Address *
City *
State *
Zip Code *
Email Address *
A form confirmation email will be sent to this address and all communication needed for your child to attend AWANA.
Phone Number *
Home Church
Emergency Contact *
First and Last Name
Relationship to Emergency Contact  *
Emergency Contact Phone Number *
Physician's Phone Number
 *
Family Physician
Insurance Company and Policy Number
 *
Allergies *
Specific Food Allergies, Medical Allergies, Chronic Illness or other
Permission to Treat Your Child: *
As parent or guardian, I hereby give permission for my child to attend AWANA Club activities.  In the event of accident or injury, I will not hold AWANA Clubs International, Roberta Baptist Church, or individual ministers or leaders responsible.  I do herewith authorize treatment for the above minor in the event of a medical emergency which, in the opinion of the attending physician, may endanger his or her life, or cause disfigurement, physical impairment or undue discomfort if delayed.  This authority is granted after a reasonable effort has been made to reach me.
Media Release Consent:
 *
Periodically pictures are taken of events in AWANA and are posted on our website or printed for club. As parent or guardian, I hereby give permission for my child's picture to be released in relation to AWANA Club activities. (If your child is in Foster Care, please indicate that below to protect the child's identity)
In what way would you be willing to help in your child's Club?
Clear selection
What Club are you registering your child for? *
Age/Grade as of Sept 1st.
Security of your child is important to us: *
The Awana leadership has my permission to dismiss my child to the following individual(s), if I am not able to pick up my children. If there is any pertinent information we need to know, pertaining to the pick up of your child(ren), please state below. If no one else is allowed to pick up your child, please state below. 
I release and absolve Roberta Baptist Church, its employees and all Awana volunteers from any responsibility or liability for any problem arising from their following my instructions recorded here.
YOUR SIGNATURE WILL BE REQUIRED AT REGISTRATION.
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