AWANA Participant's Personal Information

First Name

Last Name

Primary Address

City

State

TX

Zip Code

Home Telephone

  432-123-4567

Cellular Telephone

  432-123-4567

 Parent's Email Address

Date of Birth

  mm/dd/yyyy

Age

2 3 4 5 6 7 8 9 10 11 12 13 14

Church

School

Grade Child Will Enter in the Fall

Pre-K K 1 2 3 4 5 6 7 8

List any special needs or disabilities you want us to know about.

List any allergies we should know about.

(peanuts, bee stings...)

Father's Name

Mother's Name

Club

Puggles Cubbies Sparks T and T Trek

Is your Child a Christian?

Yes    No    I don't Know

AWANA Participant's Emergency Contact Information

Please provide someone that can be reached and respond while this child is at AWANA.

First Name

Last Name

Relationship

Select Father Stepfather Grandfather Mother Stepmother Grandmother Uncle Aunt Brother Sister Guardian Neighbor Other

Telephone

  432-123-4567

Uniform Size

Please select your child's Uniform size.

Child previously in AWANA?

Yes   No

If yes, what Book are they in?

Does you child have a uniform for their age level?

Yes   No

Please Select uniform Size Puggles 2T Puggles 3T Puggles 4T Puggles 5T Puggles 6T Cubbies Small Cubbies Medium Cubbies Large Cubbies XL Cubbied XXL Sparks Small (new) Sparks Small (classic) Sparks Medium (new) Sparks Medium (old) Sparks Large (new) Sparks Large (old) Sparks XL (new) Sparks XL (old) Saprks XXL (new) Saprks XXL (old) T and T size 10 T and T size 12 T and T size 14 T and T size 16 Trek Small Trek Medium Trek Large Trek XL Trek XXL

Payments can be mailed to, or dropped off at:

          Fellowship Community Church

          5206 N Midland Dr.

          Midland, TX 79707

Awana Scholarship Request

Request review for an AWANA Scholarship

No, thank you. Yes, please contact me.