Children's Ministry 2022-23 Registration

Primary Contact

• * First Name:
• * Last Name:
• * Email Address:
• * Confirm Email Address:
• * Address 1:
• Address 2:
• * City:
• * State: --Choose-- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming -------------- Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon Territory
• * ZIP Code:
• * Phone:
• * Emergency Contact and phone number
• * Please list the first and last name of the primary person who will pick up and drop off your child(ren), then list others who may pick up your child(ren) (if applicable).
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• Promo Code

  Enter Code: Apply

• Fee

  Type	Fee
  Awana (1 child)	$25.00
  Awana (2 children)	$50.00
  Awana (3 children)	$75.00
  Awana (4 children)	$100.00

Child(ren)'s Information

• 1st Child's Name
• 1st Child's Birthdate

• Signing up for: (check all that apply)

  • Sunday Atrium
  • Wednesday Awana
• 2nd Child's Name
• 2nd Child's Birthdate

• Signing up for: (check all that apply)

  • Sunday Atrium
  • Wednesday Awana
• 3rd Child's Name
• 3rd Child's Brithdate

• Signing up for: (check all that apply)

  • Sunday Atrium
  • Wednesday Awana

• 4th Child's Name
• 4th Child's Birthdate

• Signing up for: (check all that apply)

  • Sunday Atrium
  • Wednesday Awana
• * Are there any allergies, medical, developmental or behavioral situations we should know about? If none, please answer none.
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• Is there anyone in your family interested in volunteering in Children's ministry this year? Please give name and contact information.
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