Awana Registration
First Baptist Church of Cutler Ridge
Student Information
Name
First Name
Last Name
Birth Date
-
Month
-
Day
Year
Date
Grade
Gender
Please Select
Male
Female
Awana Class
Please Select
Puggles (2 years old)
Cubbies (3 years to K4)
Sparks (K5 to 2nd grade)
T & T (3rd to 5th grade)
Do you have another child to register?
Yes
No
Child 2 Name
First Name
Last Name
Birth Date
-
Month
-
Day
Year
Date
Grade
Gender
Please Select
Male
Female
Awana Class
Please Select
Puggles (2 years old)
Cubbies (3 years to K4)
Sparks (K5 to 2nd grade)
T & T (3rd to 5th grade)
Do you have another child to register?
Yes
No
Child 3 Name
First Name
Last Name
Birth Date
-
Month
-
Day
Year
Date
Grade
Gender
Please Select
Male
Female
Awana Class
Please Select
Puggles (2 years old)
Cubbies (3 years to K4)
Sparks (K5 to 2nd grade)
T & T (3rd to 5th grade)
Do you have another child to register?
Yes
No
Child 4 Name
First Name
Last Name
Birth Date
-
Month
-
Day
Year
Date
Grade
Gender
Please Select
Male
Female
Awana Class
Please Select
Puggles (2 years old)
Cubbies (3 years to K4)
Sparks (K5 to 2nd grade)
T & T (3rd to 5th grade)
Other Information
Primary Language
Please Select
English
Spanish
French
Creole
Other
Email Address
example@example.com
Phone Number
Please enter a valid phone number.
Is this your first time at Awana?
Yes
No
Are you a member of a church? If yes, which church?
Parent Information
Name
First Name
Last Name
Relationship to child
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Email
example@example.com
Back
Next
Emergency Contact 1
Name
First Name
Last Name
Phone Number
Relationship to child
Emergency Contact 2
Name
First Name
Last Name
Phone Number
Relationship to child
Emergency Contact 3
Name
First Name
Last Name
Phone Number
Relationship to child
Medical Information
Please list any of the following: Current medications, Medication allergies, Food allergies, Chronic health concerns.
Notes
Please inform the office of any other vital information you think they may need to know in the event of an emergency. Thank you.
Submit
Should be Empty: