AWANA REGISTRATION FORM 

CHILD'S NAME ______________________________________     Male ____ Female ____

CHILD'S AGE __________   BIRTH DATE ____/____/____   GRADE IN SCHOOL _______

ADDRESS ________________________________________________________________

CITY ____________________________________   STATE _______   ZIP _____________

PARENT'S NAME ________________________________   PHONE __________________

CELL/OTHER PHONE_______________________ EMAIL (optional)____________________

EMERGENCY CONTACT __________________________  PHONE____________________

Does your child have allergies, medical conditions or other information we should know about?
 Yes _____ (explain below)   No _____  (Use back of page if necessary)

 

Do you give permission for your child to participate in the Awana program, including Bible memorization, games and activities?   

Yes ______   No ______

Do you give permission for us to photograph your child during Awana activities and to use the photographs for promotional use?  (Any pictures used on our web site  will not be identified by name.)  

Yes ______   No ______

PARENT/GUARDIAN SIGNATURE ___________________________ 

DATE__________________________________

PLEASE MAIL THE COMPLETED FORM OR TURN IT IN  THE FIRST NIGHT YOUR CHILD ATTENDS AWANA.  THANK YOU!  

Ebenezer Awana Clubs  PO Box 233, Elverson PA  19520
610-286-9662

Located four miles east of Elverson, just off Rt 23 at 289 Warwick Furnace Road

Web Regis 07-08