Awana Registration 2017-2018
start
Hey! A payment field in this typeform can’t load in your browser. To pay and submit your responses, please view this typeform in one of these browsers.
 
Parents or Guardians First & Last Names *

 
Parent or Guardian Phone Number *

 
Parent or Guardian Street Address *

 
Parent or Guardian City/State/Zip Code *

 
Full Name of Secondary Contact in case of Emergency *

 
Secondary Contact's Relationship to Clubber *

 
Secondary Contact's Phone Number *

 
Which church does your clubber(s) attend? *


 
How many clubbers would you like to register?
Registration Fees include activity, program, and award costs. *


 
We are thrilled to have your clubbers participate in our AWANA club! For our clubbers new to AWANA, we are pleased to wave the registration fee. Your only cost will be for your clubbers 2017-18 AWANA book and uniform.

 
How many new clubbers would you like to register? *


 
Clubber #1

 
What is your clubber's first and last name? *

 
What is {{answer_56891068}}'s birthdate?
Note: Cubbies must be at least 3 years old by Sept 15 to enroll. *

 
What is {{answer_56891068}}'s grade in school? *


 
Which club will {{answer_56891068}} attend? (The Cubbies Club is now full & unable to take more clubbers) *


 
{{answer_56891068}} will need a book for {{answer_56891687}}. Would you like to purchase a {{answer_56891687}} book for $15? *

     
 
Would you like to purchase a uniform for {{answer_56891068}} ? *


 
Would you like to purchase a {{answer_56891687}} book bag ($6) for {{answer_56891068}}? *

     
 
Please list any specific medical allergies, food allergies, chronic illness, or medical conditions for {{answer_56891068}}.

 
Would you like to register another clubber? *

     
 
Clubber #2

 
What is your clubber's first and last name? *

 
What is {{answer_58237290}}'s birthdate?
Note: Cubbies must be at least 3 years old by Sept 15 to enroll. *

 
What is {{answer_58237290}}'s grade in school? *


 
Which club will {{answer_58237290}} attend? (The Cubbies Club is now full & unable to take more clubbers) *


 
{{answer_58237290}} will need a book for {{answer_58237293}}. Would you like to purchase a {{answer_58237293}} book for $15? *

     
 
Would you like to purchase a uniform for {{answer_58237290}} ? *


 
Would you like to purchase a {{answer_58237293}} book bag ($6) for {{answer_58237290}}? *

     
 
Please list any specific medical allergies, food allergies, chronic illness, or medical conditions for {{answer_58237290}}.

 
Would you like to register another clubber? *

     
 
Clubber #3

 
What is your clubber's first and last name? *

 
What is {{answer_58237329}}'s birthdate?
Note: Cubbies must be at least 3 years old by Sept 15 to enroll. *

 
What is {{answer_58237329}}'s grade in school? *


 
Which club will {{answer_58237329}} attend? (The Cubbies Club is now full & unable to take more clubbers) *


 
{{answer_58237329}} will need a book for {{answer_58237332}}. Would you like to purchase a {{answer_58237332}} book for $15? *

     
 
Would you like to purchase a uniform for {{answer_58237329}} ? *


 
Would you like to purchase a {{answer_58237332}} book bag ($6) for {{answer_58237329}}? *

     
 
Please list any specific medical allergies, food allergies, chronic illness, or medical conditions for {{answer_58237329}}.

 
Would you like to register another clubber? *

     
 
Clubber #4

 
What is your clubber's first and last name? *

 
What is {{answer_58237341}}'s birthdate?
Note: Cubbies must be at least 3 years old by Sept 15 to enroll. *

 
What is {{answer_58237341}}'s grade in school? *


 
Which club will {{answer_58237341}} attend? (The Cubbies Club is now full & unable to take more clubbers) *


 
{{answer_58237341}} will need a book for {{answer_58237344}}. Would you like to purchase a {{answer_58237344}} book for $15? *

     
 
Would you like to purchase a uniform for {{answer_58237341}} ? *


 
Would you like to purchase a {{answer_58237344}} book bag ($6) for {{answer_58237341}}? *

     
 
Please list any specific medical allergies, food allergies, chronic illness, or medical conditions of your clubber.

 
Total Cost: {{var_price}}

Registration Fees (includes activity, program, & award costs) + Books + Uniforms + Book Bags (optional)  = Total Cost
*

Sorry, your browser doesn’t support payments
 
MEDICAL RELEASE/ACTIVITY PERMIT
As a parent/guardian, I do herewith authorize participation in activities and medical treatment when required under the direction of any licensed physician of the above minor(s) in the event of a medical emergency, which, in the opinion of the attending physician, may endanger his or her life, cause disfigurement, physical impairment, or undue discomfort if delayed. This authority is granted only after a reasonable effort has been made to reach me by phone at the numbers listed below. I understand that club activities such as picnics, swim parties, skating, etc. may not necessarily take place on church premises. I give permission for my child(ren) to participate in these activities of my own free will. This includes riding/car pooling to and from Club and to different activities. The undersigned assumes the responsibility for any costs connected with such medical treatment as may be required and hereby release the church where the child attends AWANA club from any liability thereof. 

I understand that I will need to sign the Medical Release/Activity Permit upon arrival on campus. *

     
Thank you for registering your clubber(s) for AWANA! You should be receiving a confirmation email shortly.
again
Powered by Typeform
Powered by Typeform