BBC AWANA REGISTRATION FORM

Confirmation 1 Confirmation 1 I confirm that I am registering my child(ren) for AWANA.

STUDENT #1 - First, Middle & Last Name

Birthdate

Age

Baby/Toddler/Grade Level

School Child Attends

Gender Gender Male Female

Are there any allergies of which we need to be aware?

Are there any special considerations of which we need to be aware?

Is there anything else we should know about your child?

CHOOSE ONE CHOOSE ONE Puggles (Babies/Toddlers) $30 Cubbies (Preschool ages 3 & 4) $25 Sparks (Kindergarten-2nd grade) $30 T&T (3rd-5th grade) $35 Trek (6th-8th grade) $30 Journey (9th-12th grade) $40

STUDENT #2 - First, Middle & Last Name

Birthdate

Age

School Child Attends

Baby/Toddler/Grade Level

Gender Gender Male Female

Are there any allergies of which we need to be aware?

Are there any special considerations of which we need to be aware?

Is there anything else we should know about your child?

CHOOSE ONE CHOOSE ONE Puggles (Babies/Toddlers) $30 Cubbies (Preschool ages 3 & 4) $25 Sparks (Kindergarten-2nd grade) $30 T&T (3rd-5th grade) $35 Trek (6th-8th grade) $30 Journey (9th-12th grade) $40

STUDENT #3 - First, Middle & Last Name

Birthdate

Baby/Toddler/Grade Level

Age

School Child Attends

Gender Gender Male Female

Are there any allergies of which we need to be aware?

Is there anything else we should know about your child?

Are there any special considerations of which we need to be aware?

CHOOSE ONE CHOOSE ONE Puggles (Babies/Toddlers) $30 Cubbies (Preschool ages 3 & 4) $25 Sparks (Kindergarten-2nd grade) $30 T&T (3rd-5th grade) $35 Trek (6th-8th grade) $30 Journey (9th-12th grade) $40

Mailing Address (Street, City, ZIP):

Phone Number:

Father/Guardian Name:

Mother/Guardian Name:

Email Address:

Email Address:

Name & relationship of other person authorized to pick up my children:

Phone number of other person authorized to pick up my children:

Name & relationship of other person authorized to pick up my children:

Phone number of other person authorized to pick up my children:

Is there any custodial information of which we should be aware? If so, please specify:

Do you give permission to take your child(ren)'s picture for classroom projects, print, church website, church videos or Facebook? Do you give permission to take your child(ren)'s picture for classroom projects, print, church website, church videos or Facebook? Yes No

HOME CHURCH:

By completing this form you are attest that the information on the form is true and accurate to the best of your knowledge and that you understand that this program is on Sunday mornings at 9:15am. By completing this form you are attest that the information on the form is true and accurate to the best of your knowledge and that you understand that this program is on Sunday mornings at 9:15am. I agree with the above statements. Please type your name below.

Please type your name:

Date

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FOR USE BY OFFICE ONLY - PAID IN FULL BY Cash Check Online Scholarship

FOR USE BY OFFICE ONLY - NOTES