AWANA Online Registration 2023/2024 School Year (CC)

Family Information

Parent 1 Name

Parent 1 Phone

Parent 1 Email

This address will receive a confirmation email

Parent 2 Name (First, Last)

Parent 2 Phone

Parent 2 Email

Address

Home Church

Emergency Contact Information

Emergency Contact Name (First, Last)

Emergenct Contact Phone

Emergency Contact Address

Child #1

Child #1 Name (First, Last)

Child #1 Birthdate

Child #1 Gender

Child #1 - Grade entering in the fall?

Child #1 Shirt Size

Does Child #1 have allergies, special needs, or self-administered medications?

Please explain if yes:

Child #2

Child #2 Name (First, Last)

Child #2 Birthdate

Child #2 Gender

Child #2 - Grade entering in the fall?

Child #2 Shirt Size

Does Child #2 have allergies, special needs, or self-administered medications?

Please explain if yes:

Child #3

Child #3 Name (First, Last)

Child #3 Birthdate

Child #3 Gender

Child #3 - Grade entering in the fall?

Child #3 Shirt Size

Does Child #3 have allergies, special needs, or self-administered medications?

Please explain if yes:

Child #4

Child #4 Name (First, Last)

Child #4 Birthdate

Child #4 Gender

Child #4 - Grade entering in the fall?

Child #4 Shirt Size

Does Child #4 have allergies, special needs, or self-administered medications?

Please explain if yes:

Child #5

Child #5 Name (First, Last)

Child #5 Birthdate

Child #5 Gender

Child #5 - Grade entering in the fall?

Child #5 Shirt Size

Does Child #5 have allergies, special needs, or self-administered medications?

Please explain if yes:

Transportation

Van space is very limited, but if they need a ride, select "Yes".

By selecting 'Yes' you authorize Southern Hills Baptist Church vans to transport your child/children to and from activities.

Do your children need a ride?

Photo Release

I grant permission for images of my child/children , captured during any Awana activity, through video, photo or digital camera, to be used as a display/record of Awana events and/or for the purpose of promoting participation in Awana activities.

Payment Information

Please select the number of children from the dropdown.

Payment

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

AWANA Online Registration 2023/2024 School Year (CC)

Description

Please Fix the Following