2022-23 Awana Course Registration Form

Student Registration Form

Wednesdays 6:30-8:00 p.m. 2022-23
#1 Student Name

First NameLast NameGrade Level in fall
Birth Date

MonthDayYear
Gender
#2 Student Name

First NameLast NameGrade Level in fall
Birth Date

MonthDayYear
Gender
#3 Student Name

First NameLast NameGrade Level in fall
Birth Date

MonthDayYear
Gender
#4 Student Name

First NameLast NameGrade Level in fall
Birth Date

MonthDayYear
Gender
Address*

Street Address

CityState / Province

Postal / Zip Code
Parent/Guardian Name
Mobile Number
Format: (000) 000-0000.
Parent/Guardian E-mail
example@example.com
Person bringing and picking up child(ren)
Allergies/Health or Learning Concerns
By signing below, you as parent/ guardian indicate that as parent/guardian you will do your part to ensure your clubber understands and follows the rules and expectations. As a parent/guardian, you also have the responsibility to help your child at home with their handbooks.
I, as parent or guardian with legal responsibility for child(ren) listed on this form, hereby grant Crossroad Community Church to perpetual right to use photographs or video taken of my child/dependent for any legitimate purpose without compensation to my child/dependent, myself, or my child's heirs. Legitimate purposes may include, but are not limited to, advertising on the web, on social media, in internal publications, displayed prints, worship services, special events, curriculum, etc.
Should be Empty:

Student Registration Form