AWANA Registration Form

AWANA 2021-22 Registration Form

Please fill in the form below.
Parent Name *

First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Phone Number *

Area Code Phone Number
Who's Number *

Mom Dad
E-mail
Please check this box if you give consent for Highland Park AWANA ministries to photograph your child(ren) and use that photo for printed and electronic media purposes. If your child is under 12, we will not post your child’s name with his/her photo without requesting separate permission to do so.
Child's Name *

First Name Last Name
Male Female
Date of Birth *

Month Day Year
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 grade Dive: 3rd-6th grade
Child #2 Name

First Name Last Name
Male Female
Date of Birth

Month Day Year
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 grade Dive: 3rd-6th grade
Child #3 Name

First Name Last Name
Male Female
Date of Birth

Month Day Year
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 grade Dive: 3rd-6th grade
Child #4 Name

First Name Last Name
Male Female
Date of Birth

Month Day Year
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 grade Dive: 3rd-6th grade
Child #5 Name

First Name Last Name
Male Female
Date of Birth

Month Day Year
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 grade Dive: 3rd-6th grade
Club Dues

Please choose one option below and fill out quantities based on how many children you are registering. Enter "0" for all other options not selected.
Yearly (1 Child): $10 *
Quantity
Yearly (2 Children): $15 *
Quantity
Yearly (3 or more Children): $20 *
Quantity
Total Amount From This Section
Handbooks

Please select the number of handbooks needed. Enter "0" for all other options not selected.
Cubbies: $12 each *
Quantity
Sparks: $12 each *
Quantity
Dive (3rd-6th): $7 each *
Quantity
Total Amount From This Section
Total Amount Due

Please calculate total amount due from all sections. Please pay all dues at the office at Highland Park Church or the first night of AWANA. Make checks payable to Highland Park Church and put "AWANA" on the memo line. You may also pay online at Ministries Fund | Highland Park Ministries. Please be sure to put "AWANA" in the "Leave a Comment" box.
Total Amount Due: *
Signature *

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AWANA 2021-22 Registration Form

Club Dues

Handbooks

Total Amount Due