Awana 2017 Registration

Sept. 13: Awana Family Night & Registration 6:00-7:30 pm
Sept. 20: First Club Night 6:00-7:30 pm

* Indicates required field

Mother/Guardian Name *

First

Last

Family Street Address *

City, State *

Email *

Cell Phone Number *

Home Number *

Father/Guardian Name *

First

Last

Address *

Cell Phone Number *

Home Phone Number *

Adult Participation - Is Vital to the Children's Ministry at ECC. Please sign up for an area you would like to serve. *

Emergency Contact / Relationship *

Emergency Contact Phone Number *

Your Home Church *

Any Special Needs: Learning, Behavior, Diet, Medical, Allergies ---- What can we do to help with these needs? *

Child 1 Name *

First

Last

Birthday *

Grade Completed *

Dietary/Allergies *

Child 2 Name *

First

Last

Birthday *

Grade Completed *

Dietary/Allergies *

Payment Information *

Cubbies (3 1/2 - Pre-K) - $20.00 Each Sparks (K-2nd Grade) - $20.00 Each T&T (3rd-6th Grade) - $20.00 Each

Total Entered Here Please *

(write Awana in memo line of check)

Click the Box Below if You are asking for Scholarship *

Scholarship Requested

Child 3 Name *

First

Last

Birthday *

Grade Completed *

Dietary/Allergies *

Child 4 Name *

First

Last

Birthday *

Grade Completed *

Dietary/Allergies *

I can pay this of the total amount. I am asking for scholarship for the balance *

Please Check *

I will respect my child’s leader by promptly picking up my child by 7:30 pm I understand that I must drop off/pick up my child in their assigned areas I give permission for my child’s image to be used in any ECC publication promotional materials or slide shows, including the ECC website.

Submit

Sept. 13: Awana Family Night & Registration 6:00-7:30 pmSept. 20: First Club Night 6:00-7:30 pm

Sept. 13: Awana Family Night & Registration 6:00-7:30 pm
Sept. 20: First Club Night 6:00-7:30 pm