2018-2019 Awana Registration

Please select a group correlating with your child's grade.
Name *
Name
Birthdate *
Birthdate
Guardian's Name(s) *
Guardian's Name(s)
Address *
Address
Cell Phone *
Cell Phone
Home Phone
Home Phone
Emergency Contact Cell Phone # *
Emergency Contact Cell Phone #
Are there any medical problems or allergies that we should know about?
Name 2
Name 2
Select a group correlating with your child's grade.
Birthdate
Birthdate
Name 3
Name 3
Select group correlating with your child's grade.
Birthdate
Birthdate
Name 4
Name 4
Birthdate
Birthdate
Permission *
My child has permission to participate in the Awana Program at Concord Baptist Church during the 2018-2019 year. Concord Baptist has my permission to seek appropriate medical care for my child in the event that it is needed and I cannot be reached. Concord may also take photos of my child to use for AWANA promotional purposes only.
Name of Parent filling out form. This will serve as a digital signature for permission stated above.
Select group correlating with your child's grade.