Parent or Guardian Name (s)
Parent or Guardian Email (s)
Parent or Guardian Phone Number
Emergency Contact Name
Emergency Contact Phone
Child 1 Name
Child 1 Grade
Child 1 Birthdate
Month
Day
Year
Child 2 Name (If not applicable, please skip this question.)
Child 2 Grade (If not applicable, please skip this question.)
Child 2 Birthdate (If not applicable, please skip this question.)
Month
Day
Year
Child 3 Name (If not applicable, please skip this question.)
Child 3 Grade (If not applicable, please skip this question.)
Child 3 Birthdate (If not applicable, please skip this question.)
Month
Day
Year
Child 4 Name (If not applicable, please skip this question.)
Child 4 Grade (If not applicable, please skip this question.)
Child 4 Birthdate (If not applicable, please skip this question.)
Month
Day
Year
Additional Children's Names/Grades/Birthdates
Allergies: Does your child have any allergies? If yes, please list them. Please list each child separately. If none, please write “None.”
Special Concerns: Please let us know about any learning disabilities, sensory sensitivities, triggers, physical limitations, or other concerns we should know about your child. Please list each child separately. If none, please write “None.”
Any additional information that can help us come alongside your family?
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Awana 2026
