Awana Clubber Registration 2022

1
How many children will you register today?* This field is required.If more than 6, please continue this form for the first 6, and then return to fill out this form again for the remaining children.
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Parent Name(s)* This field is required.If none, type None.
Mother/Guardian Full Name
Father/Guardian Full Name
3
Parent Contact Information* This field is required.
Parent email address
Main phone number
Alternative phone number
4
Home Address* This field is required.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
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Emergency Contact* This field is required.
Emergency Contact Full Name
Emergency Phone
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Child 1 Information* This field is required.
Child 1 First Name
Child 1 Last Name
Please Select
Please Select
PK
K
1
2
3
4
5
6
Grade
Birth Date
Select one
Select one
Youth XS
Youth S
Youth M
Youth L
Youth XL
Adult S
Adult M
Adult L
Adult XL
Adult 2XL
Shirt size
None
Peanuts/nuts
Eggs/milk/dairy
Penicillin/amoxicillin
Seasonal/pollen
Bees/insects
Berries
Wheat/gluten
Allergies
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Child 2 Information* This field is required.
Child 2 First Name
Child 2 Last Name
Please Select
Please Select
PK
K
1
2
3
4
5
6
Grade
Birth Date
Select one
Select one
Youth XS
Youth S
Youth M
Youth L
Youth XL
Adult S
Adult M
Adult L
Adult XL
Adult 2XL
Shirt size
None
Peanuts/nuts
Eggs/milk/dairy
Penicillin/amoxicillin
Seasonal/pollen
Bees/insects
Berries
Wheat/gluten
Allergies
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Child 3 Information* This field is required.
Child 3 First Name
Child 3 Last Name
Please Select
Please Select
PK
K
1
2
3
4
5
6
Grade
Birth Date
Select one
Select one
Youth XS
Youth S
Youth M
Youth L
Youth XL
Adult S
Adult M
Adult L
Adult XL
Adult 2XL
Shirt size
None
Peanuts/nuts
Eggs/milk/dairy
Penicillin/amoxicillin
Seasonal/pollen
Bees/insects
Berries
Wheat/gluten
Allergies
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Child 4 Information* This field is required.
Child 4 First Name
Child 4 Last Name
Please Select
Please Select
PK
K
1
2
3
4
5
6
Grade
Birth Date
Select one
Select one
Youth XS
Youth S
Youth M
Youth L
Youth XL
Adult S
Adult M
Adult L
Adult XL
Adult 2XL
Shirt size
None
Peanuts/nuts
Eggs/milk/dairy
Penicillin/amoxicillin
Seasonal/pollen
Bees/insects
Berries
Wheat/gluten
Allergies
10
Child 5 Information* This field is required.
Child 5 First Name
Child 5 Last Name
Please Select
Please Select
PK
K
1
2
3
4
5
6
Grade
Birth Date
Select one
Select one
Youth XS
Youth S
Youth M
Youth L
Youth XL
Adult S
Adult M
Adult L
Adult XL
Adult 2XL
Shirt size
None
Peanuts/nuts
Eggs/milk/dairy
Penicillin/amoxicillin
Seasonal/pollen
Bees/insects
Berries
Wheat/gluten
Allergies
11
Child 6 Information* This field is required.If you have more than 6 children, please submit this form and then go back to fill out this form again for the remaining children.
Child 6 First Name
Child 6 Last Name
Please Select
Please Select
PK
K
1
2
3
4
5
6
Grade
Birth Date
Select one
Select one
Youth XS
Youth S
Youth M
Youth L
Youth XL
Adult S
Adult M
Adult L
Adult XL
Adult 2XL
Shirt size
None
Peanuts/nuts
Eggs/milk/dairy
Penicillin/amoxicillin
Seasonal/pollen
Bees/insects
Berries
Wheat/gluten
Allergies
12
How will you pay for registration?* This field is required.
Online - Take me to the payment page
In person (Hand in to David Kozuch)
I need payment assistance/scholarship
13
Pay Awana Fees * This field is required.IMPORTANT: Registration will not complete until payment is made on the PayPal page at the end of this registration form. If you change your mind, go back and select another payment method BEFORE clicking Submit on the next page.
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My Bag
0
My Bag
Great Product Name
$20
Quantity:1
Size:Small
RemoveEdit
Great Product Name
$20
Quantity:1
Size:Small
RemoveEdit
Great Product Name
$20
Quantity:1
Size:Small
RemoveEdit
Great Product Name
$20
Quantity:1
Size:Small
RemoveEdit
ORDER SUMMARY
Total costUSD
Awana Fee (for families with more than one child)Fee covers the child's shirt and book.
$35.00Edit
Back
Awana Fee (for single child)Fee covers the children's shirts and books.
$20.00Edit
Back
Total cost $0.00
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Please confirm your agreement:* This field is required.Check the box below.
15
Are you interested in donating your Wednesday evenings to help the Awana program? * This field is required.We will contact you with volunteer opportunities.
YES, I can!!! I'll think about it...
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