NCC Awana Registration Form 2011-2012

Please complete all fields to register for the Newark Community Church AWANA club. Club meets Wednesday nights 6:45p-8:30p from September 14, 2011 till May 23, 2012.

* Required

Club Cubbies (Pre-K), must be potty trained; Sparks (K-2nd grade); T&T (3rd-6th grade); Trek (7th-8th grade); Journey (9th-12th grade)

First * Clubber's first name

Last * Clubber's last name

Street Address *

City *

ZIP *

Email Address *

Age *

Gender *

Grade *

Birthday *

Church

Home Phone *

Cell Phone * Enter multiple numbers if applicable

Parent's Name *

Authorized Person 1 * Sixth grade and younger children must be signed in and out at their group's room

Authorized Person 2

Authorized Person 3

Emergency Contact *

Emergency Phone *

Allergies/Special Needs

Security Policy * Sixth grade and younger children must be signed in and out at their group's room. You must bring yoru child to their room and sign them in. You cannot just drop them off out front. Children will only be released to a non parent or sibling (12 or older) with pre-arranged authorization. Please identify the Authorized Person(s) to pick up your child in the section above. If this changes please let us know.

I have read and understand the security Policy