AWANA Registration and Release Form 2020-21
Please register here and click submit!
Parent/Guardian Name
*
Additional Parent/Guardian (if applicable)
Primary Email (announcements will go here)
*
This address will receive a confirmation email
Cell Phone (which you can be reached during club time!)
*
Address
*
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AA
AB
AE
AK
AL
AP
AR
AS
AZ
BC
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
YT
Home Church (if any)
*
Material Delivery Choice
*
Please select one option.
Pick up at Church
Deliver to Home (Mail or Drop Off)
Child #1
Child #1 Name
*
M/F
*
Please select one option.
M
F
Age
*
Grade
*
Please select one option.
3-4 years old
K
1st
2nd
3rd
4th
5th
6th
Select Option
3-4 years old
K
1st
2nd
3rd
4th
5th
6th
Birthday
*
Child #2
Child #2 Name
M/F
Please select one option.
M
F
Age
Grade
Please select one option.
3-4 years old
K
1st
2nd
3rd
4th
5th
6th
Select Option
3-4 years old
K
1st
2nd
3rd
4th
5th
6th
Birthday
Child #3
Child #3 Name
M/F
Please select one option.
M
F
Age
Grade
Please select one option.
3-4 years old
K
1st
2nd
3rd
4th
5th
6th
Select Option
3-4 years old
K
1st
2nd
3rd
4th
5th
6th
Birthday
Child #4
Child #4 Name
M/F
Please select one option.
M
F
Age
Grade
Please select one option.
3-4 years old
K
1st
2nd
3rd
4th
5th
6th
Select Option
3-4 years old
K
1st
2nd
3rd
4th
5th
6th
Birthday
Payment (per family)
Payment ($15/child; $45/family cap); (Scholarships are available as well. Please talk to Jolene Aho about this!)
($15)
($30)
($45)
Will Pay in Person (0)
($15)
($30)
($45)
Will Pay in Person (0)
Amount
Credit/Debit Card Number
Expiration Date/CVC
Name on Card
Card Billing Address
AA
AB
AE
AK
AL
AP
AR
AS
AZ
BC
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
YT
Submit
Description
Please register here and click submit!
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