AWANA Registration 2021-2022 School Year

Child's Name

Date of Birth

Age

Grade

Siblings Attending

Parent Name

Address

City

State

Zip

Home Phone

Cell Phone

Work Phone

Church Home

Emergency Contact (persons to contact in case parents cannot be reached)

Name

Phone
Relationship to Child

Name
Phone
Relationship to Child

Allergy/Health Conditions

My child has permission to attend and participate in AWANA for the 2019-2020 school year, a ministry of Excelsior Springs Baptist Church.

Yes

Date

My child has permission to be photographed/video graphed as part of AWANA.

Yes

Date