CABC AWANA 2021-2022 Registration Form

Child's Name *

First Name

Last Name

Parent / Guardian Name *

First Name

Last Name

Parent Phone *

(###)

###

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Home Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Emergency Contact Name *

First Name

Last Name

Emergency Contact Phone *

(###)

###

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Child's Date of Birth *

MM

DD

YYYY

My Child Needs A Uniform *

Cubbies Vest - Preschool Sizes: (8), (10) $12.00 Sparks Vest - Kindergarten - 2nd grade Sizes: L, XL, 2XL, 3XL $12.00 Truth & Training Uniform - 3rd - 6th grade Sizes: (Child) 14, (Adult) Small, Medium, Large $16.00

Yes

No

My Child Needs A Handbook (Optional) *

Handbooks (NKJV) are $12.00 each

Yes

No

I give permission for photos to be taken of my child(ren) for internal viewing purposes only *

Yew

No

I give permission for emergency medical attention in the event that I am not reachable *

Yes

No

I warrant that my child is fully capable of safely participating in all Awana Activities & release CABC/Awana from all liabilities resulting from these activities *

Yes

No