Rock Prairie Church

My child is going to attend AWANA:*
- In Person
- Online
Student Name*
First Last
Birth Date*
MM slash DD slash YYYY
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Home Phone
Parent/Guardian Name*
First Last
Email*
Emergency Contact*
First Last
Relationship*
Emergency Contact Phone*
Special Considerations*
Siblings also attending AWANA*
Consent Form*
I give my permission for the child listed above to participate in AWANA activities and games, and I realize that even when carefully supervised there is a chance that he/she could get hurt. I will not hold the church and/or its representatives liable for injury, and I give permission for the above named child to be treated in case of an emergency.
Parent Name for Consent*
First Last
Date*
MM slash DD slash YYYY

Cubbies AWANA Registration