Awana Registration

Contact Information
Name*
FirstLast
Email*
Address*
Street AddressAddress Line 2CityZIP Code
Home Phone*
Please provide your primary Home number as follows: (###)### - ####
Primary Mobile Number*
Please provide your primary Mobile number as follows: (###)### - ####
Current Church You Attend
Child Registration
Awana Child Registration*
Please complete the available fields for each child enrolled in Awana. Additional children can be added by selecting the + button.

Note: For the Awana Class field please indicate if child will be in: Puggles (under 3 years old); Cubbies (potty-trained 3 to 5 year olds); Sparks (Kindergarten to 2nd graders); T&T (3rd to 6th graders).
First Name Last Name Date of Birth Grade Awana Class
Special Needs / Concerns*
Please document any special needs and/or allergic reactions specific to your children. Please ensure careful detail is made in clarifying individual needs. If your child has no special needs please write "None" in the space provided:
Emergency Contact*
List an emergency contact, bearing the unavailability of parents.
Emergency Contact Phone Number*
Home or Mobile Emergency Contact Phone Number.
Release Signature*
In some instances, photographs are taken of children’s ministry activities for public and promotional purposes, which include, but are not limited to, in-house presentations, church web sites, brochures and newsletters. Individual names and/or contact information are never used without specific permission. By selecting the check box below, you are releasing Westbrook to use photographs of your child for purposes as stated above.
- Parent/Guardian Signature
Medical Release Signature*
In case of emergency, I hereby authorize my child to be treated by Certiﬁed Emergency Personnel. (i.e. EMT, First Responder, E.R. Physician)
- Parent/Guardian Signature
Be Prayerful About Serving This Year
Volunteer Opportunities
Please choose one or more service opportunities below:
- Cubbies - Be a substitute when leaders are absent on club night
- Cubbies - Tell the story at Large Group time
- Sparks - Be a substitute when leaders are absent on club night
- Sparks - Tell the story at Large Group time
- T&T - Be a substitute when leaders are absent on club night
- T&T - Tell the story at Large Group time
- Carnival night assistance
- Christmas Program coordinator
- Christmas Program assistance
- Club night set-up assistance
- Club night tear down / clean up assistance
- Grand Prix assistance
Payment Details
Promotional Code
Awana Registration Payment*
Please choose one of the options below to indicate the total number of children you are registering for the 2012-2013 Awana club year.
- One Child Registration
- Two Children Registered
- Three Children Registered
- Four Children Registered
Awana Leader Registration Payment*
The promotion code has been accepted. Please choose one of the options below to indicate the total number of children you are registering for the 2012-2013 Awana club year.
- One Child Registration
- Two Children Registered
- Three Children Registered
- Four Children Registered
Total Registration Cost
Total registration Cost for Awana Club.
$0.00

Contact Information

Child Registration

Be Prayerful About Serving This Year

Payment Details