AWANA Registration and Medical – First Baptist Church

Name

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Current Grade

Age

Birth Date

Allergies/Medical Information

Parent/Gurdian Name

First

Last

Phone Number

Emergency Contact Name (other than parent)

Emergency Contact Phone Number

Brought By (Van or Parent Pick-up) Van runs inside city limits only

Authorized Pickup Person(s)

Home Church

May we have permission to photograph your child?

May we have permission to use your child's photograph in church publications/social media posts?

Additional Information (not required)

Do You Have Additional Children to Register?

If you select "yes," extra fields will appear for you to fill out. If you need to add information for more than one child, click the "add" button at the bottom of the form to include additional fields for each child. If you don’t have any additional children to add, simply select "no" and you can submit the form.