AWANA Registration

Clubber Name & Home Information
Clubber's Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Birth Date*
Date Format: MM slash DD slash YYYY
Grade*
Parent/Guardian Information
Parent's Name*
First Last
Email*
Phone*
Church Information
Are You A Member Of A Church?*
Church Name*
Invited By*
Allergies/Medical Concerns
Any Allergies Your Child Might Have*
Please List Any Medical Concerns That May Affect Your Child During AWANA (ex. asthma, seizures...)*
Emergency Contact Information
Name*
First Last
Relationship to Child*
Phone*
SPBC Release
I, the parent/guardian listed above, grant SPBC permission to use my child's name, photos, audio recordings, and DVD's made at any SPBC event for the purpose of publicity, promotional materials, and website content.
Check the box below to either agree or disagree to the Marketing Release*
- I agree
- I do not agree
Parent/Guardian Name - by typing your name again you are signing this as a legal document. You must be 18 yrs. old or older to submit this form. *
Parent/Guardian Name*
First Last
Date*
Date Format: MM slash DD slash YYYY

Bible Study | 9:30a Worship | 10:45a

Clubber Name & Home Information