Awana Clubs Registration

Parent Information

Parents Name

Address

Phone (on Wednesday Nights)

Emergency Contact

Emergency Contact Phone #

List any other adults allowed to pick up your child

This address will receive a confirmation email

Home Church Attended

My child has permission to participate in AWANA at Bethel Community Church. I am aware that every precaution will be taken for the safety of my child. However, in the event of an emergency where I, or my emergency contact person is not reachable, I give my permission to the AWANA staff to obtain medical services. Please indicate consent below

I Agree and Consent

Initials:

By checking this box, I am indicating that I DO NOT GIVE Permission for my child/children's image to be used on Bethel Community Church's authorized social media accounts. No

Child #1 Information

Name

Gender Male Female

Birthdate

Grade (this Fall)

Puggles - For ages 2-3 (before August 31st).

Cubbies -
Boys and girls age three years old by August 31, 2017 through four years old.

Sparks - Boys and girls that are beginning Kindergarten through 2nd grade.

Truth and Training (aka.T&T) -
Boys and girls that are beginning 3rd through 6th grade.

Grade/Club This Fall

Puggles Cubbies Sparks T&T

New to AWANA?

T-Shirt Size

Allergies Information

Child #2 Information

Name

Gender Male Female

Birthdate

Grade (this Fall)

New to Awana? Yes No

T-Shirt size

Club Puggles Cubbies Sparks TNT

Allergies Information

Child #3 Information

Name

Gender Male Female

Birthdate

Grade (this Fall)

Club Puggles Cubbies Sparks TNT

New to AWANA?

T-Shirt size

Allergies Information

Child #4 Information

Name

Gender Male Female

Birthdate

Grade (this Fall)

Club Puggles Cubbies Sparks TNT

New to AWANA?

T-Shirt size

Allergies Information

Child #5 Information

Name

Gender Male Female Option

Birthdate

Grade (this Fall)

T-Shirt size

Club Puggles Cubbies Sparks TNT

New to AWANA?

Allergies Information

Payment & Dues

The cost is $35 for each child enrolled in Awana clubs. This cost covers dues, books, and uniform (if needed), and to offset the cost of the program.

If Paying by check, please select the check option and enter the desired amount, please indicate check # and amount in the "additional payment details" field.

One child: $35
Two children: $70
Three children: $105
Four children: $140
Five children: $175

If unable to pay at time of registration please indicate so and any additional details in the "additional payment details" field.

Payment

Check # and Amount / Additional Payment Details

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Awana Clubs Registration - 2018-2019

Description

Awana Clubs Registration - 2018-2019

Description

Please Fix the Following