AWANA Registration 2020-21

Name (required)

Age (required)
34567891011121314

Date of Birth (required) mm-dd-yyyy

Last Grade Completed (required)
3yrs4yrsPre-KK12345

Address (required)

City (required)

State (required)

ZIP (required)

Parent/Guardian (required)

Contact Phone (required)

Alternative Phone

E-mail

Do you have a church home? Yes or No
YesNo

Church Name?

Emergency Contact (required)

Emergency Contact Number (required)

Medical Allergies (required) Enter N/A if None

Being the legal guardian of the minor named herein, I give Heber Springs Baptist Church and/or its sponsors the authority to secure any medical and/or surgical treatment for the child names above that is determine necessary in the event of an emergency, sickness, or accident.

I authorize the following people (in additions to the parents listed above) to pick up my child from any AWANA sponsored gatherings.

I give permission for photos or videos of AWANA activities which may contain my child to be used on Heber Springs Baptist Church media platforms.
YesNo

This year we are offering AWANA in our traditional Wednesday night club night or an alternative online AWANA program. With the online program the student will have AWANA videos they can watch and then participate in the book time like our traditional program. Please select the button below as to which method is best suited for your child.
Traditional ProgramOnline Program

Questions? If you have any questions about our AWANA program, please let us know.

Please leave this field empty.