2017-18 - LCF Awana Online Registration

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Child’s Name:

Parent/Guardian Name(s):

Parent/Guardian Primary Phone:

Parent/Guardian Secondary Phone:

Mailing Address:

Home Email Address:

Child’s Birth Date:

Child’s Gender:

Uniform Size:

Church your family attends (if any):

In case of emergency (when the parent/guardian cannot be reached) the church should contact:



Relationship to Child:

Please list any allergies, medical or other special conditions the Awana Leaders should be aware of:

Other individuals that may be responsible for picking up this child at the end of Awana club night:



Relationship to Child:


Enter the text you see below

Child’s Grade:

Family Physician:

Physician’s Phone:

Format: mm/dd/yyyy