Parent/Guardian Name *
Parent/Guardian Name
Phone *
Phone
Address
Address
Emergency Contact - Phone Number *
Emergency Contact - Phone Number
Please list anyone other than the Parent/Guardian who is allowed to pick up your child. If you'd like your child to walk home, please let us know.
Birth Date *
Birth Date
Birth Date
Birth Date
Birth Date
Birth Date
Birth Date
Birth Date

Please note: this form pre-registers your child. You will still need to come in to the church to sign a release form for your child on their first week. Unless otherwise noted on the pick-up/drop-off instructions, parents are expected to bring their children into the church for AWANA. If you have any questions, please contact the church office