2019 Awana Registration

Child's Name *

First

Last

Gender *

Date of Birth *//

Grade / Age *

School

Allergies / Restrictions

Home Address *

Address Line 1

Address Line 2

City

State

Zip Code

Father's Name *

First

Last

Father's Email *

Father's Phone *

Mother's Name *

First

Last

Mother's Email *

Mother's Phone *

Name of Home Church (if attending)

Home Church Location

Please check the Awana Club your child will be attending: *

Puggles (Ages 1 & 2)
Cubbies (Ages 3 & 4)
Sparks (Grades K - 2nd)
T-n-T (Grades 3rd - 6th)

Permission / Consent / Release of Liability

I, the undersigned, request that my child(ren) be permitted to participate in the Welcome Home Christian Church (aka WHCC) Awana Ministry. I agree to hold harmless WHCC or any of their agents in the event of accident, illness, injury, or death, which may occur during any and all AWANA sponsored activities. I hereby consent to my child's participation in interviews, the use of quotes and the taking of photographs, movies, or video tapes while participating in a WHCC activity or function. I also grant permission to WHCC to use my child's name and/or photographs for use in brochures, newsletters, and webpages, as well as other forms of media not mentioned. I also hereby release WHCC from all claims, demands, and liabilities whatsoever in connection with the above.

E-Signature of Parent or Guardian *

Date *

Please list those who are AUTHORIZED to pick up your child from Awana

Authorized Name *

First

Last

Relationship

Phone

Authorized Name *

First

Last

Relationship

Phone

EMERGENCY CONTACT

Emergency Contact Name *

First

Last

Emergency Contact Relationship *

Emergency Contact Phone *

Emergency Contact Name

First

Last

Emergency Contact Relationship

Emergency Contact Phone

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