Awana Registration Parent/Guardian Name * First Name Last Name Phone * (###) ### #### Email * Address Address 1 Address 2 City State/Province Zip/Postal Code Country Home Church FIRST CHILD'S INFORMATION First Child's Name * First Name Last Name First Child's Birthdate * MM DD YYYY First Child's Grade N/A Pre-K K 1 2 3 4 5 First Child's Medical Information/Special Needs SECOND CHILD'S INFORMATION Second Child's Name First Name Last Name Second Child's Birthdate MM DD YYYY Second Child's Grade N/A Pre-K K 1 2 3 4 5 Second Child's Medical Information/Special Needs THIRD CHILD'S INFORMATION Third Child's Name First Name Last Name Third Child's Birthdate MM DD YYYY Third Child's Grade N/A Pre-K K 1 2 3 4 5 Third Child's Medical Information/Special Needs FOURTH CHILD'S INFORMATION *If you have more than four children, please fill out a second form. Fourth Child's Name First Name Last Name Fourth Child's Birthdate MM DD YYYY Fourth Child's Grade N/A Pre-K K 1 2 3 4 5 Fourth Child's Medical Information/Special Needs EMERGENCY CONTACT Name of Emergency Contact (other than Parent) * First Name Last Name Emergency Contact Phone * (###) ### #### Relationship to Child(ren) Thank you for registering for Awana!