AWANA REGISTRATION

This form must be completed by the PARENT or LEGAL GUARDIAN of the children listed below. We take the physical safety of children very seriously. Thank you for completing this form in its entirety before coming to your first night of Awana.
If you have more than 3 children to register, please complete a second form.
Click here to read the "Awana Liability/Medical/Image Release Form" before completing this registration.

Parent or Legal Guardian Name *
Parent or Legal Guardian Name
Primary Phone *
Primary Phone
Secondary Phone
Secondary Phone
Address *
Address
EMERGENCY CONTACT INFO
Check the box below if emergency contact is same as above. (If so, you may leave these emergency fields blank.)
Emergency Contact Primary Phone
Emergency Contact Primary Phone
Emergency Contact Secondary Phone
Emergency Contact Secondary Phone
INSURANCE: DBC’s insurance is only secondary insurance. If you have medical insurance, your carrier will be billed for medical charges in case of illness or injury while your child is at Awana club.
Alternate Pickup Information
Alternate Pickup Name
Alternate Pickup Name
Alternate Pickup Phone
Alternate Pickup Phone
CHILD #1
Child #1 Name *
Child #1 Name
Child #1 Gender *
(Food allergies, medications, etc)
CHILD #2 (If no other children, you may skip to the RELEASE at the bottom of this form)
Child #2 Name
Child #2 Name
Child #2 Gender
CHILD #3
Child #3 Name
Child #3 Name
Child #3 Gender
LIABILITY/MEDICAL/IMAGE RELEASE
Are you the parent or legal guardian of all minors listed in this registration, and as such do you agree to the Awana liability, medical, and image releases included below? *

Click here to read the 2017-18 Awana Liability/Medical/Image Release Form. (TIP: If you have just filled out the form but not yet submitted it, right click on "click here" and select "Open link in new tab." Then you can come back to this tab and hit "Submit" after you've read the release form.)