Parent/Guardian Contact Info

First Name

Last Name

Phone Number

Address

Apartment, suite, etc.

City

State

Postal / Zip Code

Do you attend a local church?

Yes

If "yes" we'd love to know which one

If "no" would you like someone to reach out to you to learn more about Strasburg Community Church?

Sure

No thanks

I'm interested in learning how I can help out in Awana

Yes

If you're interested in helping out at Awana, we'll reach out to you to let you know how you can.

Child Info

Child #1

Child #1 Class

Cubbies (Ages 4-PK)

Sparks (Grades K-2nd)

T&T (Grades 3rd-5th)

Got another kid to register?

Yes

Child #2

Child #2 Class

Cubbies (Ages 4-PK)

Sparks (Grades K-2nd)

T&T (Grades 3rd-5th)

Any more kiddos to register?

Yes

Child #3

Child #3 Class

Cubbies (Ages 4-PK)

Sparks (Grades K-2nd)

T&T (Grades 3rd-5th)

Any more kids to sign up?

Yes

Child #4

Child #4 Class

Cubbies (Ages 4-PK)

Sparks (Grades K-2nd)

T&T (Grades 3rd-5th)

Another awesome kid to sign up?

Yes

Child #5

Child #5 Class

Cubbies (Ages 4-PK)

Sparks (Grades K-2nd)

T&T (Grades 3rd-5th)

*If you need to register additional children, please complete this form in its entirety and then begin a new one

Medical/Personal Info

All information will be kept confidential and private

Do any of your children have allergies?

Yes

Please list the child's name and allergies

Are there any special needs we need to be aware of (physical, developmental, emotional, etc.)?

Yes

Please describe so we can make accommodations, if needed

Are there any custody issues we need to be aware of that could present a safety or security issue?

Yes

Please describe. If you would like to discuss this with someone, let us know and we'll reach out to you.

Emergency Contact Info

In the event of an emergency, please list below the best person to contact.

Emergency Contact

Phone Number

Relation

Parent/Guardian

Grandparent

Neighbor/Friend

Awana Information

Awana starts Wednesday, September 6th from 6:30p-7:45p
You may begin dropping off your child at 6:15p
Registration cost is $10/child with a $40 cap for all families.
Registration payment will be collected on the first night of Awana

Once you're finished, click the "Submit" button below

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