AWANA CLUB REGISTRATION FOR BEREAN BAPTIST CHURCH

Please fill out this form once for each child you would like to register and click submit.

Child's Full Name

*

Child's Age

*

Child's Grade (Last Completed)

*

Please select one option.

Pre-K Kindergarten 1st 2nd 3rd 4th 5th

Child's Date of Birth

*

Parent/Guardian Name

*

Email

*

This address will receive a confirmation email

Address (incl. City, State, & Zip Code)

*

Phone (cell)

*

Name of Home Church

Emergency Contact's Name

*

Emergency Contact's Phone (must be available 7-8:15 pm Wednesdays)

*

Child's Allergies/Medical Concerns (put N/A if none)

*

Child's Shirt Size

*

Please select one option.

Youth Small Youth Medium Youth Large Adult Small Adult Medium

Description

Please fill out this form once for each child you would like to register and click submit.

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