Awana Registration

Child Personal Information
Child's Name*
First Last
Date of Birth*
Age*

Must be age 3 by September 1, 2021 through 6th grade
Grade*
Gender*
Additional Children
If you are registering multiple children under the same parent/guardian please select the total number of children.
2nd Child
Child's Name*
First Last
Date of Birth*
Age*

Must be age 3 by September 1, 2021 through 6th grade
Grade*
Gender*
3rd Child
Name*
First Last
Date of Birth*
Age*

Must be age 3 by September 1, 2021 through 6th grade
Grade*
Gender*
4th Child
Name*
First Last
Date of Birth*
Age*

Must be age 3 by September 1, 2021 through 6th grade
Grade*
Gender*
5th Child
Name*
First Last
Date of Birth*
Age*

Must be age 3 by September 1, 2021 through 6th grade
Grade*
Gender*
6th Child
Name*
First Last
Date of Birth*
Age*

Must be age 3 by September 1, 2021 through 6th grade
Grade*
Gender*
Parent/Guardian Personal Information
Parent/Guardian Name(s)
Mailing Address
Street Address (If different from mailing address)
City
State
Zip
Phone
Phone 2
Email
Emergency Contact Information
(In case parent/guardian cannot be reached)
Name*
Relationship to child*
Phone*
Alternate Phone
Medical Information
Food/drug allergies
Medication taken on a regular basis
Any medical condition of which we should be aware
Permission and Release
I hereby give my permission for my child to participate in activities sponsored by the Awana Club of First Baptist Church Grapeland for the club year of 2021 - 2022. I further give my permission for First Baptist Church Grapeland or its representatives/sponsors of the activity to secure needed medical treatment in the event that I cannot be reached for such permission. I release First Baptist Church Grapeland and its representatives/sponsors from liability for accident or injuries. I hereby accept all the risks of injury associated with the above mentioned activity in which my child is participating at First Baptist Church Grapeland.*
- Yes
- No
Signature of Parent/Guardian*

By typing your name here, you are signing this application electronically. You agree your electronic signature is the legal equivalent of your manual signature on this application.
Date
MM slash DD slash YYYY
Section Break

Child Personal Information

2nd Child

3rd Child

4th Child

5th Child

6th Child

Parent/Guardian Personal Information

Emergency Contact Information

Medical Information

Permission and Release

Section Break