AWANA

September 9, 2026 6:30 PM - 8:15 PM

Cubbies (3yrs-PreK), Sparks (K-2nd), T&T (3rd-6th)

Type

Quantity

Child 0

Age Groups: Cubbies (3yrs-PreK), Sparks (K-2nd), T&T (3rd-6th)

Child's First Name *

Child's Last Name *

Child's Gender *

Child's Age *

Child's Date of Birth *

Child's School Grade *

Club Age Group *

Special Needs Child *

Child's Allergies or Special Information (Medications, Activity Restrictions, etc...) *

Parent/Guardian First Name *

Parent/Guardian Last Name *

Email Address *

Phone Number *

Preferred Method(s) of Contact *

Phone Call

Text

Home Address *

Home City *

Home State *

Home Zip Code *

Emergency Contact (other than parent/guardian: NAME / PHONE # / RELATIONSHIP TO CHILD) *

Please list the names and relationships of all people who are permitted to transport your child home after club. *

Do you attend a church? *

Do you attend New Buffalo Alliance Church? *

May we add your phone number to our automated call system to receive an alert in the event that AWANA is cancelled? *

Photo Consent and Release *

Liability Waiver *