Welcome to Online Registration for AWANA

If you prefer to print the form, fill it out, sign it, and bring it or send it with your child, click here for a printable form.       

Please complete all areas of the form before clicking "submit."

Clubber Name:   

Parent/Guardian Name:

Address:

City:   State:    Zip code:

Phone:     Email address: 

Clubber age/grade:     Clubber birthday:           

Hobbies/activities:

Siblings (names/ages):

Church:

Medical conditions:

Brought by (transportation):

Invited by:

Individuals authorized to pick up from club:

May we have permission to photograph your child?  YES       NO

Authorization for Club Leader to contact your child/children, send written correspondence, phone call, or home visit to see how they are enjoying the club and to discuss club activities: YES                          NO                  Date:         

AWANA Games Permission 

This gives parent/guardian permission for your child to participate in the games.

My child     has my permission to participate in the AWANA Games hosted by Country Acres Baptist Church in Wichita, Kansas. I give permission for the staff to administer minor first aid if necessary. I also give my consent for treatment at the nearest facility if deemed necessary. Parents/Guardians will be notified if more than first aid is needed.

Name of Insurance Company      

Policy Number   

Parent/Guardian Name    

Parent or Guardian signature is required on the form. If you register online, you will need to come and sign the form in person on the first night when the club meets.