AWANA Registration

Please fill out the following information to register for AWANA.

Child's Name *

Street Address *

Street Address, Line 2

City *

State *

Zip Code *

Gender * MaleFemale

Date of Birth *

Grade *

Medical Instructions/Allergies

Siblings at AWANA

Parent/Guardian Name *

Parent/Guardian Email

Mobile Phone *

Other Phone

Church You Attend

Emergency Contact Name *

Emergency Contact Phone *

Adult Authorized to Pick up Child

I hereby give my permission for my child to participate in AWANA Clubs. I authorize the staff of DBBC to obtain emergency medical treatment for my child if he/she becomes ill and I am unable to be contacted. *
I agree

I understand that I or an authorized adult must be present at check-in and dismissal every day of AWANA Clubs for the safety of my child. *
I agree

I hereby authorize DBBC to use photographs and videos of my child for publicity and promotional purposes which include, but are not limited to, in-house presentations, church websites, brochures, and newsletters. Children's names and other personal information are never used without specific permission. *
I agree

I would like to register my child to be served dinner on Wednesday nights at 5:45pm. We will only have enough food to accommodate those pre-registered for dinner. *
YesNo

How did you hear about AWANA? *

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