AWANA Registration
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Child's Name *
Address *
Full Mailing Address
Birthday *
MM
/
DD
/
YYYY
Age *
Grade *
Gender *
Church *
Home Church (if attending)
Parent/ Guardian 1 Name *
Parent/ Guardian 1 phone number *
Parent/ Guardian 1 email  *
Parent/ Guardian 2 Name  *
Parent/ Guardian 2 phone number *
Parent/ Guardian 2 email 
Emergency Contact *
Other than parent
Emergency Contact Phone # *
Are there any custodial arrangements we need to be aware of? *
If previous question is yes, please provide necessary details.
Allergies *
Medications
Medical Conditions
Physical, Emotional, Mental
Health Care Number *
Family Dr.  *
Comments

Anything you want us to know about your child so that we can best support them:

Media Permission *

I,                                              (parent/guardian)give permission that photos may be taken of my child for Club purposes (slideshows, club projects, AWANA Facebook).

Checking below acts as your signature.

Check all that apply:

Required
Payment *
Registration Fee is $70.00. 
How will you be paying?
For E-Tranfser, please include in the description, "AWANA REGISTRATION-CHILD'S NAME" to offerings@southridge.co
Cheques payable to Southridge Community Church
PARENT PERMISSION *
This is my digital signature that the above information is accurate. 
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