AWANA Registration

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Name of Parents or Guardians:

Address:

City:

State:

Zip:

Email Address:
Your e-mail address will only be used to notify you of upcoming Awana events.

Number to call in case of an emergency:

Best Contact #:

As parent or guardian, I give permission for my child to receive emergency medical treatment if I cannot be reached after a reasonable amount of time:

Doctor's Name:

Doctor's Phone #:

Health Insurance Company:

Health Insurance Address:

Health Insurance Policy Number:

Enter one or more children below

New Child Record

Child's First Name:

Child's Last Name:

Date of Birth:

Grade:

Gender:

Date of last Tetanus booster:

Special Medications:

Known Allergies:

Is your child able to participate in physical activity for Game Time. If not please explain:

Grace Baptist Church of Laurel may periodically take photos of the AWANA children for promotional purposes. By submitting this form you agree to let your child's photograph be used in this manner.

Please enter the words you see in the box below, in order and separated by a space. Doing so helps prevent automated programs from abusing this service. If you are not sure what the words are, either enter your best guess or click the reload button next to the distorted words.

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