Registration for AWANA 2025-2026
Please fill out this form and click submit.
Clubber Name
*
Address
*
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AA
AB
AE
AK
AL
AP
AR
AS
AZ
BC
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
YT
Email Address
*
This address will receive a confirmation email
Grade Entering in Fall
*
Parent 1
*
Parent 1 Cell Phone
*
Parent 2
Parent 2 Cell Phone
Clubber Date of Birth
*
Emergency Contact and Cell Phone Number
*
Do you currently attend a church?
*
Please select one option.
Yes
No
If yes, please list the church your family attends:
MEDICAL INFORMATION
*** Please Note ***
This information is strictly confidential and is only required in case of unforseen medical emergency for your child's protection. Thank you for your cooperation.
Has your child ever experienced or been diagnosed with the following:
*
Please select all that apply.
Fainting Spells
Convulsions
Asthma
Nose Bleeds
Diabetes
Heart Problems
Hay Fever
Nervous Condition
Special Handicaps
Allergies to bee stings
NONE
Other
If Other, please list:
Does your child have any allergies?
*
Please select all that apply.
Yes
No
If your child has allergies, please describe:
Does your child require medications that we should be aware of?
*
Please select all that apply.
Yes
No
If your child requires medication, please list:
Does your child have any restrictions?
*
Please select one option.
Yes
No
If your child has any restrictions, please describe:
AWANA ACTIVITY PARTICIPATION AGREEMENT By checking YES below, the participant (or parent/guardian, if participant is a minor) acknowledges and accepts the risks of physical injury associated with participation of our hayride and caroling event. Except for gross negligence on the part of the sponsor, the participant (or parent/guardian) accepts personal financial responsibility for any bodily or personal injury sustained during the activity. Further, the participant (or parent guardian) promises to hold harmless the sponsoring organization and its representatives for any injury related to the activity.
*
Please select one option.
YES to both Hayride and Caroling
NO to both Hayride and Caroling
YES to Hayride ONLY
YES to Caroling ONLY
Other
If OTHER selected, please specify.
Submit
Description
Please fill out this form and click submit.
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