AWANA Registration

Human Verification

Ten minus five equals

Registration Form

Registering for club:(required)
First Name(required)
Last Name(required)
Grade
Date of Birth(required)
Address(required)
City
State
Zip Code
E-Mail(valid email required)
Home Phone(required)
Cell Phone 1(required)
Cell Phone 2
Mom's Name(required)
Dad's Name(required)
Name of person bringing / picking up child(required)
Name of child's doctor
Emergency Contact Name (other than parents)(required)
Emergency Contact Phone 1(required)
Emergency Contact Phone 2
Home Church
Invited to AWANA by
I am interested in helping with AWANA

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