Awana Clubs Family Registration Father's Name First Name Last Name Father's Address Address 1 Address 2 City State/Province Zip/Postal Code Country Father's Home Phone (###) ### #### Father's Cell Phone (###) ### #### Father's Email Address Is father permitted to take child from church? * Yes No Mother's Name First Name Last Name Mother's Address (if different than father's) Address 1 Address 2 City State/Province Zip/Postal Code Country Mother's Home Phone (if different than father's) (###) ### #### Mother's Cell Phone (###) ### #### Mother's Email Address Is mother permitted to take child from church? Yes No Emergency Contact #1 First Name Last Name Contact #1 Relationship Contact #1 Phone (###) ### #### Is Contact #1 permitted to take child from the church? Yes No Emergency Contact #2 First Name Last Name Contact #2 Relationship Contact #2 Phone (###) ### #### Is Contact #2 permitted to take child from the church? Yes No Is anyone NOT permitted to take your child(ren) from the church? Is anyone else (in addition to the persons listed above) permitted to take your child(ren) from the church? Child #1 * First Name Last Name Child #1 Gender * Male Female Child #1 Birthdate * MM DD YYYY Child #1 Grade in Fall * Preschool Kindergarten Grade 1 Grade 2 Grade 3 Grade 4 Grade 5 Grade 6 Child #1 lives with * Both Parents Father Mother Other Child #1 ADDITIONAL INFORMATION - Allergies, medical conditions, or any other information that will assist us in providing appropriate supervision and care for your child. Child #2 First Name Last Name Child #2 Gender Male Female Child #2 Birthdate MM DD YYYY Child #2 Grade in Fall Preschool Kindergarten Grade 1 Grade 2 Grade 3 Grade 4 Grade 5 Grade 6 Child #2 lives with Both Parents Father Mother Other Child #2 ADDITIONAL INFORMATION - Allergies, medical conditions, or any other information that will assist us in providing appropriate supervision and care for your child. Child #3 First Name Last Name Child #3 Gender Male Female Child #3 Birthdate MM DD YYYY Child #3 Grade in Fall Preschool Kindergarten Grade 1 Grade 2 Grade 3 Grade 4 Grade 5 Grade 6 Child #3 lives with Both Parents Father Mother Other Child #3 ADDITIONAL INFORMATION - Allergies, medical conditions, or any other information that will assist us in providing appropriate supervision and care for your child. Child #4 First Name Last Name Child #4 Gender Male Female Child #4 Birthdate MM DD YYYY Child #4 Grade in Fall Preschool Kindergarten Grade 1 Grade 2 Grade 3 Grade 4 Grade 5 Grade 6 Child #4 lives with Both Parents Father Mother Other Child #4 ADDITIONAL INFORMATION - Allergies, medical conditions, or any other information that will assist us in providing appropriate supervision and care for your child. Thank you for for registering your family for Awana.
