Awana Registration Clubber Name*Date of Birth*Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Parents Names*Parents Email* Main Phone*Home ChurchClub Assignment*Cubbies (3-4 year olds)Sparks (Grades K-2)T&T Boys (Boys, Grades 3-4)T&T Boys (Boys, Grades 5-6)T&T Girls (Girls, Grades 3-4)T&T Girls (Girls, Grades 5-6)TREK (Grades 7-8)JOURNEY (Grades 9-12)Does the clubber need a uniform?Check any uniforms or accessories you would like to order. These items may also be ordered at a later date. Cubby Vest - $12 Cubby Bag - $7 Sparks Vest - $12 Sparks Bag - $7 T&T Bag - $9 T&T Uniform - $22 Uniform size, if needed. Cubby - 4 Cubby - 5 Cubby - 6 Spark - 6 Spark - 8 Spark - 10 Spark - 12 Spark - 14 Does the clubber need to purchase a new book?Books are $10 each for Cubbies, Sparks,T&T, and Trek. Books are $18 each for Journey.YesNoNot SureIs your clubber interested in participating in the Grand Prix in November? If so cars can be purchased for $7.50 each.YesNoNot SureName of Emergency Contact*Phone for Emergency Contact*I hereby authorize the leaders of AWANA to act on my behalf when I cannot be contacted, IN CASE OF AN EMERGENCY, resulting in the need of medical attention for my child named above. I also agree to hold harmless the AWANA leadership and First Baptist Church of Silvis, IL, from any accidents as a result of my child's participation in its activities. Furthermore, I agree to reimburse First Baptist Church, Silvis, IL for all medical expenses.*I agreeI understand that photographs will be taken throughout the Club Year which may be used as part of the Parents and Awards Night slide presenttaion. I hereby give my permission for my child to be photographed for this purpose. I further understand that if I do not wish my child to be photographed, it is my responsibility to notify the Club Commander.*I agreeEmailThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.