Language
English (US)
Awana Registration 2020-2021
Thank you for registering your child for Awana! This registration form is good for the 2020-2021 school year (August-May). We will start back in January on Wednesday, January 13th and end on Wednesday, May 5th. We will not have Awana on March 31st or April 7th for Holy Week and spring break. We are thrilled to have you at Awana!
Child Information
Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Gender
*
Male
Female
Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Same address as child?
*
Yes
No
School Name & Grade
*
Enrolling In
*
Nursery (infant to 3 years)
Cubbies (Pre-K)
Sparks (K-2nd grades)
T&T (3rd-5th grades)
T-Shirt Size
*
Youth XS (2-4)
Youth S (6-8)
Youth M (10-12)
Youth L (14-16)
Adult S
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Parent/Guardian Information
Name
*
First Name
Last Name
Email
*
example@example.com
Address (if different from child)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
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Next
Emergency Contacts
Emergency contacts must be a legal adult (18 or older), and live nearby in case of emergency, and we are not able to get ahold of parent/guardian.
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Relationship to Child/Family
*
Permitted to pick-up child?
*
Yes
No
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Relationship to Child/Family
Permitted to pick-up child?
Yes
No
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Next
Medical Information
Please answer in detail if applicable or write N/A.
List all medical conditions or concerns of child (i.e. asthma, allergies, diabetes, epilepsy/seizures, etc.) Please type N/A if there are none.
*
Any additional pertinent information (physical challenges, behavioral challenges, sensory processing challenges, etc.) Please type N/A if there are none.
*
List all allergies (i.e. peanuts, pollen, mold, penicillin, etc.) Please type N/A if there are none.
*
Photo Permission
Your child may be photographed while participating in the activities of Mosaic Church. Do you give permission for photographs of your children to be used by Mosaic Church on its website, social media platforms, and other church materials?
Yes
No
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