Awana, Cubbies & Pearls Registration Parent's Name * First Name Last Name Address Address 1 Address 2 City State/Province Zip/Postal Code Country Phone * (###) ### #### Email * May we text you? * Yes, please No, thank you Emergency Contact (other than stated parent) * First Name Last Name Emergency Contact Phone Number * (###) ### #### Children's Information Name of Child * First Name Last Name Child's Date of Birth * Which program are you registering this child for? * Cubbies (Preschool Boys & Girls Age 3-4) Awana (Boys & Girls K thru 2nd grade) Pearls (Young ladies in grades 3-12 / Ages 8-18) Child's Grade * Child's Address Add Street Address, City, State, and Zip (if different than above) Does this child have allergies? * If "yes," please specify. Add 2nd Child Name of 2nd Child First Name Last Name 2nd Child's Date of Birth Which program are you registering this child for? Cubbies (Preschool Boys & Girls Age 3-4) Awana (Boys & Girls K thru 2nd grade) Pearls (Young ladies in grades 3-12 / Ages 8-18) 2nd Child's Grade 2nd Child's Address Add Street Address, City, State, and Zip (if different than other family members) Does this child have allergies? If "yes," please specify. Add 3rd Child Name of 3rd Child First Name Last Name 3rd Child's Date of Birth Which program are you registering this child for? Cubbies (Preschool Boys & Girls Age 3-4) Awana (Boys & Girls K thru 2nd grade) Pearls (Young ladies in grades 3-12 / Ages 8-18) 3rd Child's Grade 3rd Child's Address Add Street Address, City, State, and Zip (if different than other family members) Does this child have allergies? If "yes," please specify. Add 4th Child Name of 4th Child First Name Last Name 4th Child's Date of Birth Which program are you registering this child for? Cubbies (Preschool Boys & Girls Age 3-4) Awana (Boys & Girls K thru 2nd grade) Pearls (Young ladies in grades 3-12 / Ages 8-18) 4th Child's Grade 4th Child's Address Add Street Address, City, State, and Zip (if different than other family members) Does this child have allergies? If "yes," please specify. Thank you! Your completed registration form has been received. You may now close this window.
