Union Church AWANA

AWANA 2008 REGISTRATION FORM

Child Information
First Name	Last Name

Gender	Age
Male Female
Date of Birth (mm/dd/yy)	Grade Entering this Fall

Parent/Guardian Information
First Name	Last Name

Mailing Address	City

State	ZIP Code

Home Phone (###-###-####)	Cell Phone (###-###-####)

E-mail Address	Home Church (if any)

Emergency Information
Emergency Contact Name*	Relation to Child

Home Phone	Cell Phone

Child's Allergies	Other Information

Parent/Guardian Authorization
Adults Authorized to Pick Up Your Child (must be 18 years or older)

By clicking submit, you state that your child's registration information is accurate, your child is authorized to participate in the club, and you will adhere to the parent handbook. Though signed in, your child is still under your supervision until their club room is opened and you have delivered them to their club room (see handbook for T&T exception). AWANA reserves the right to ID any adult before releasing a child. Please refer to the parent handbook for all club practices.