AWANA – Child Registration

Please fill in all the fields below to register your child for AWANA. Club dues are $20 per child/year or $1 per week (24 weeks). We will NOT deny any child because of inability to pay dues. Guest clubbers are not expected to pay dues.

Child's Name*

Date of Birth*

Grade*

Allergies/Medical/Special Needs Diagnosis*

Mother/Guardian Name

Mother/Guardian Phone

Father/Guardian Name

Father/Guardian Phone

Additional Emergency Contact*

Child's Address*

Additional Children from the Same Household

Other adults authorized to pick up children

I give LAC AWANA Clubs permission to photograph my child/children.*

Yes

Do you want to receive AWANA reminders and closings via text messages?*

Yes