Awana Registration Please enable JavaScript in your browser to complete this form.Child's Name *FirstLastGender *MaleFemaleDate of Birth *MM123456789101112/DD12345678910111213141516171819202122232425262728293031/YYYY202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Grade / Age *Ages 1 & 2Age 3Age 4 / Pre-K (4)K1st2nd3rd4th5th6thSchoolAllergies / RestrictionsHome Address *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeFather's Name *FirstLastFather's Email *Father's Phone *Mother's Name *FirstLastMother's Email *Mother's Phone *Name of Home Church (if attending)Home Church LocationPlease 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)Please select your child's T-Shirt size (Youth): *X-SmallSmallMediumLargeX-LargePermission / Consent / Release of LiabilityI, 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 AwanaAuthorized Name *FirstLastRelationshipPhoneAuthorized Name *FirstLastRelationshipPhoneEMERGENCY CONTACTEmergency Contact Name *FirstLastEmergency Contact Relationship *Emergency Contact Phone *Emergency Contact NameFirstLastEmergency Contact RelationshipEmergency Contact PhoneNameSubmit