2017/2018 AWANA Club Registration
2017/2018 AWANA Club Registration
Please provide information about your child:
Child’s Name (First & Last)  * 
Child’s Date of Birth (Format: MM/DD/YY)  * 
Child’s Gender  * 
Age Group (Class)  * 
Child’s Shirt Size  * 
Does this child have allergies?  * 
If this child has allergies, please describe them below:
Please provide information about an emergency contact:
Name of Emergency Contact (First & Last)  * 
Phone Number of Emergency Contact (Format: 843-873-7887)  * 
Child’s Doctor’s Name  * 
Child’s Doctor’s Phone Number (Format: 843-873-7887)  * 
Please provide information about yourself as the child’s parent/guardian:
Your Name (First & Last)  * 
Your Cell Phone Number (Format: 843-873-7887)  * 
Your Email Address  * 
Your Home Address * 
The following individuals are authorized to pick up my child from AWANA:
There is a registration fee of $25 per child. Would you like to pay this right now online?  * 
Total $
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