AWANA Registration

2021-2022 Student Registration

Term: September 15, 2021 - May

* Indicates required field

Date: (MM/DD/YYYY) *

Child/Student

Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Birthdate (MM/DD/YYYY): *

Age: *

Grade in 2021-2022: *

Gender: *

Male Female

Preferred Phone Number *

Preferred Number Is: *

Home Phone Mobile Phone

Preferred Email: *

First Time Visitor? *

Yes No

Church You Attend: *

MorningStar CC Other church We don't currently have a home church.

Church You Attend If Other: *

Allergies or Medical Conditions: *

A. Family Contact Information

Mother's Name: *

First

Last

Other Parent/Legal Guardian Name: *

First

Last

Relationship to the child/student if other: *

Phone Number: *

Email: *

Father's Name: *

First

Last

Other Parent/Legal Guardian Name: *

First

Last

Relationship to the child/student if other: *

Phone Number: *

Email: *

B. Emergency Contact Information (If Father or Mother Can't Be Reached)

Emergency Contact Name: *

First

Last

Emergency Contact Phone Number: *

Emergency Contact Relationship: *

Emergency Contact Address: *

Line 1

Line 2

City

State

Zip Code

Country

Submit

Register for AWANA

2021-2022 Student Registration

​Child/Student

A. Family Contact Information

B. Emergency Contact Information (If Father or Mother Can't Be Reached)

Child/Student