Awana Clubs 2023-2024

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Name

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Parent's Name

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Address

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Email

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This address will receive a confirmation email

Phone

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Check one

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Please select all that apply.

Male Female

Birthdate

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Grade

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On Church Property - What Class?

Years in Awana

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Emergency Contact (Other than Parent)

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Church which Family is presently attending?

Authorized Pick-ups

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Does your child have any physical limitations which would prohibit him/her from participating in game time?

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Please select one option.

Yes No

Does your child have any allergies? If so, please list them.

*

I (Parent) am interested in helping Awana:

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Please select one option.

Weekly Special Events As needed No Thanks

I authorize Northside Baptist Church Awana Commander/ Leaders to obtain emergency medical care for my child in the event of an emergency. I understand that every effort will be made to locate a parent or guardian. I will not hold Northside Baptist Church or its leaders responsible for any injury that might occur while my child participates in the Northside Baptist Church Awana Clubs.

*

Please select all that apply.

Yes No

Photos and videos of children may be taken during Awana and special events.

Payment

Club Fee ($25.00) I will pay in office. ($0)

Amount

Credit/Debit Card Number

Expiration Date/CVC

Name on Card

Card Billing Address

Description

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