Awana Registration
Parent Name
*
First Name
Last Name
E-mail
*
Cell Phone Number
*
-
Area Code
Phone Number
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
CHILDREN INFORMATION
Number of children being registered for AWANA Program
*
Please Select
0
1
2
3
4
5
1st Child's Name
*
First Name
Last Name
1st Child's Gender
Male
Female
1st Child's Date of Birth
*
-
Month
-
Day
Year
Date Picker Icon
1st Child's Grade Entering This Fall
*
Has Child #1 participated in AWANA before?
*
Yes
No
Not sure
2nd Child's Name
*
First Name
Last Name
2nd Child's Gender
Male
Female
2nd Child's Date of Birth
*
-
Month
-
Day
Year
Date Picker Icon
2nd Child's Grade Entering This Fall
*
Has Child #2 participated in AWANA before?
*
Yes
No
Not sure
3rd Child's Name
*
First Name
Last Name
3rd Child's Gender
Male
Female
3rd Child's Date of Birth
*
-
Month
-
Day
Year
Date Picker Icon
3rd Child's Grade Entering This Fall
*
Has Child #3 participated in AWANA before?
*
Yes
No
Not sure
4th Child's Name
*
First Name
Last Name
4th Child's Gender
Male
Female
4th Child's Date of Birth
*
-
Month
-
Day
Year
Date Picker Icon
4th Child's Grade Entering This Fall
*
Has Child #4 participated in AWANA before?
*
Yes
No
Not sure
5th Child's Name
*
First Name
Last Name
5th Child's Gender
Male
Female
5th Child's Date of Birth
*
-
Month
-
Day
Year
Date Picker Icon
5th Child's Grade Entering This Fall
*
Has Child #5 participated in AWANA before?
*
Yes
No
Not sure
Would you be interested to learn more about serving in our AWANA program?
*
Yes
No thank you
Comments
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*
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