AWANA Registration Awana Registration How many children are you signing up?12345Child InformationChild 1Name First Birthdate Month Day Year AgeGradeClubSelect ClubCubbies/Preschool: 3 by Sept 1 & 4 year oldsSparks: K-2 Co-edT&T: 3-6 Girls/BoysYouth: Girls/BoysGender Male Female Child InformationChild 2Name First Birthdate Month Day Year AgeGradeClubSelect ClubCubbies/Preschool: 3 by Sept 1 & 4 year oldsSparks: K-2 Co-edT&T: 3-6 Girls/BoysYouth: Girls/BoysGender Male Female Child InformationChild 3Name First Birthdate Month Day Year AgeGradeClubSelect ClubCubbies/Preschool: 3 by Sept 1 & 4 year oldsSparks: K-2 Co-edT&T: 3-6 Girls/BoysYouth: Girls/BoysGender Male Female Child InformationChild 4Name First Birthdate Month Day Year AgeGradeClubSelect ClubCubbies/Preschool: 3 by Sept 1 & 4 year oldsSparks: K-2 Co-edT&T: 3-6 Girls/BoysYouth: Girls/BoysGender Male Female Child InformationChild 5Name First Birthdate Month Day Year AgeGradeClubSelect ClubCubbies/Preschool: 3 by Sept 1 & 4 year oldsSparks: K-2 Co-edT&T: 3-6 Girls/BoysYouth: Girls/BoysGender Male Female Parent InfoAddress Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Home PhoneCell PhoneCell PhoneEmail Address For church use only for upcoming events and cancellations - it will not be shared or sold.Church You Currently AttendSchool You Are Currently AttendingParents or Guardian Names First Names of Additional Individuals Who Can Pick Up Your ChildrenPlease also include your relationship to these individuals.Family PhysicianPhoneSpecific medical allergies, chronic illnesses, or other conditions ANOTHER PERSON TO CONTACT IN CASE OF EMERGENCY:Name First PhoneUniform and Book OrderIf you wish to order an AWANA uniform, please fill the lines below. First, specify which uniform your child needs from the list below. 3 & 4 year olds - Cubbies vest Kindergarten, 1st and 2nd grade - Sparks red vest (boy/girl) 3rd, 4th, 5th, and 6th grade - T&T Polo Shirt Next, specify your child's size Cubbies - M, L, XL, XXL Sparks - M (8), L (10), XL (12), XXL (14), XXXL (16) T&T Polo Shirt - S, M, L, XL (adult size) Example: Cubbies, M To order more than one uniform, click the plus button on the right. List How many books would you like to order?012345How many bags would you like to order?012345Book 1 Cubbies - $11 Sparks - $11 T&T - $11 Book 2 Cubbies - $11 Sparks - $11 T&T - $11 Book 3 Cubbies - $11 Sparks - $11 T&T - $11 Book 4 Cubbies - $11 Sparks - $11 T&T - $11 Book 5 Cubbies - $11 Sparks - $11 T&T - $11 Bag 1 Sparks (optional) - $6.50 T&T Sling Bag (optional) - $9.50 Bag 2 Sparks (optional) - $6.50 T&T Sling Bag (optional) - $9.50 Bag 3 Sparks (optional) - $6.50 T&T Sling Bag (optional) - $9.50 Bag 4 Sparks (optional) - $6.50 T&T Sling Bag (optional) - $9.50 Bag 5 Sparks (optional) - $6.50 T&T Sling Bag (optional) - $9.50 As Parent and/or Guardian, I do hereby authorize the treatment by a qualified and licensed medical doctor of the above minor(s) in the event of a medical emergency which, in the opinion of the attending physician, may endanger his/her life, cause disfigurement, physical impairment, or undue discomfort if delayed. This authority is granted only after a reasonable effort has been made to reach me. This release form is completed and signed of my own free will with the sole purpose of authorizing medical treatment under emergency circumstances in my absence for the Awana Club year, September 4, 2024 - May 7, 2025. I agree with the statement abovePlease understand that an inherent risk of exposure to COVID-19 exists in any public place where people are present. COVID-19 is a contagious disease that can lead to a potentially life-threatening illness. According to the Centers for Disease Control and Prevention, senior citizens and guests with underlying medical conditions are especially vulnerable. By attending our Awana program you voluntarily assume all risks related to exposure to COVID-19.Signed: First FatherMotherGuardianDate MM slash DD slash YYYY CAPTCHA