Awana 2020-2021

If you or your child would like to participate in this event as a Participant, please complete the following form.

(If you are under 18, please have your parent or guardian complete the form.)
Personal Information

*Participant's First Name:
*Participant's Last Name:
*Parent/Guardian Name:
*Address:
*City:
*State:
*Zip:
*Cell Phone:
(555-555-5555)
*Email:
*Birthday:
(MM/DD/YYYY)
*Gender:
*Last Grade Completed:
Allergies, Medical, & Special Needs:
(Leave Blank if None)
*Emergency Contact Name (1):
*Emergency Contact Phone (1):
(555-555-5555)
Emergency Contact Name (2):
Emergency Contact Phone (2):
(555-555-5555)
*Authorized Pickup #1:
Authorized Pickup #2:
Authorized Pickup #3:
Authorized Pickup #4:
Awana Dues:
(Awana Dues are $25 per child with a $75 family maximum. These are due by October 15. Scholarships are available, please see Rachel Antrim.)
May we have permission to photograph your child?
May we have permission to use your child's photograph in church publications?