Awana

AWANA and Youth Registration 2015

* Indicates required field

Parent or Guardian Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Best Contact Phone Number *

Emergency Contact Name *

First

Last

Emergency Contact Phone Number *

Child Name *

First

Last

Choose One (For School aged children, please check the grade your child is current in) *

What School does your child attend? *

Please List any allergies or health conditions in which staff needs to be aware *

I give Living Water permission to take pictures and use them on the church's social media and web site *

Submit