Midweek Registration Form 2023-24

Midweek 2023-24 Registration Form

Please fill in the form below.
Parent Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
Who's Number*

MomDadOther
E-mail
I give consent for Highland Park AWANA/DIVE ministries to photograph my child(ren) and use that photo for printed and electronic media purposes. If my child is under 12 years old, Highland Park will not post my child's name with his/her photo without requesting seperate permission to do so.
Please choose an option.*

I give my permission for my child(ren) to be photographed.I DO NOT give my permission to photograph my child(ren)
Child's Name*

First NameLast Name
MaleFemale
Date of Birth*

MonthDayYear
Date
School Name or Home-School*
Grade*
Allergy or medical condition we should be made aware*
Please check which club your child will participate*

Puggles: Infant-2yrs (One parent must be a leader)Cubbies: 3 yr- 4yr (Must be potty-trained)Sparks: K-2nd gradeDive: 3rd-6th grade
Child #2 Name

First NameLast Name
MaleFemale
Date of Birth

MonthDayYear
Date
School Name or Home-School
Grade
Allergy or medical condition we should be made aware
Please check which club your child will participate

Puggles: Infant-2yrs (One parent must be a leader)Cubbies: 3 yr- 4yr (Must be potty-trained)Sparks: K-2nd gradeDive: 3rd-6th grade
Child #3 Name

First NameLast Name
MaleFemale
Date of Birth

MonthDayYear
Date
School Name or Home-School
Grade
Allergy or medical condition we should be made aware
Please check which club your child will participate

Puggles: Infant-2yrs (One parent must be a leader)Cubbies: 3 yr- 4yr (Must be potty-trained)Sparks: K-2nd gradeDive: 3rd-6th grade
Child #4 Name

First NameLast Name
MaleFemale
Date of Birth

MonthDayYear
Date
School Name or Home-School
Grade
Allergy or medical condition we should be made aware
Please check which club your child will participate

Puggles: Infant-2yrs (One parent must be a leader)Cubbies: 3 yr- 4yr (Must be potty-trained)Sparks: K-2nd gradeDive: 3rd-6th grade
Club Costs

This year we have included the dues and handbook cost together. This means you pay $20 for each child. Child 4+ is free. Puggles is for the Awana/Dive workers only. The cost for Puggles is free for these workers. Ex- Child 1=$20, Child 2=$20, Child 3=$20, Child 4=Free Total=$60
Yearly (1-3 Children): $20 per child (4th+ child is free)*
Number of Children
Total Amount
Please make all payments the first night of AWANA or at the Highland Park Church office. Make checks payable to Highland Park Church and put "AWANA" on the memo line. You may also pay online at Ministries Fund. Please be sure to put "AWANA" in the "Leave a Comment" box.
Signature*

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Midweek 2023-24 Registration Form

Club Costs