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2020-2021 Awana Club
Registration & Medical Release
Please complete one form for each child.
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Clubber's Name
*
Your answer
Gender
*
Male
Female
Parent's Name
*
Your answer
Street Address
*
Your answer
City, State and Zip
*
Your answer
Phone number
*
Your answer
Email Address
*
Your answer
Birthday
*
MM
/
DD
/
YYYY
Grade
*
Choose
PK-3
PK-4
Kindergarten
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
Age
*
Your answer
Has clubber ever attended Awana club at another church?
*
Yes
No
If yes, what is the last book or award
Your answer
Does your child have any physical, emotional, mental or behavioral concerns or limitations that our staff should be award of? (Please explain)
Your answer
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