Please bring cash or a check, payable to Crossroads Fellowship, for $30 per clubber to the AWANA registration table. Thank You!

Students Name

First Name

Last Name

Gender

Male

Female

Birth Date

Birth date of the AWANA Club student

MM

DD

YYYY

Student Age (Fall 2024)

Grade (Fall 2024)

Grade AWANA Club student will be attending in Fall

Parent/Guardian

First Name

Last Name

Home Phone

(###)

###

####

Cell Phone

(###)

###

####

Email

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Member of a Church

Yes

No

If yes, which Church?

Has your child been involved in AWANA previously?

Yes

No

If yes, which club?

If yes, which book did they last complete?

Emergency Contact (only used if parents cannot be reached)

First Name

Last Name

Emergency Contact Number

(###)

###

####