Child's Name

Child's Age

Child's Birthday (month/day/year)

Grade

Allergies/health info

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Parent/guardian name(s)

Home address

City/ZIP

Telephone

Cell phone

Email

Home church

Brought/invited to Awana by

Person(s) authorized to pick up child from club

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The child registered above has my permission to participate in Immanuel Bible Church sponsored Awana Clubs. I, the parent/guardian of above clubber, have read the CLUB GUIDELINES & PROCEDURES with them and I will encourage my clubber to abide by them and to achieve his/her best. I understand that pictures of this event may include my child’s image, but not their name, will be used for IBC publicity purposes.