Join Us on Wednesday nights during the months of September - April.

Awana Registration

Please Fill out the below form to register your child. (All items with an * are required)

First name

Last name

Date of Birth

Grade

Street Address

Street Address Line 2

City

Region/State/Province

Postal / Zip code

Parent/Guardian Name

Parent/Guardian Phone

Parent/Guardian Email

Emergency Contact

Emergency Contact Relationship with Child

Emergency Contact Phone Number

Important Medical Information (medication, allergies, etc.)

Insurance Company

Insurance ID #

Doctors Name and Phone #

Terms and Conditions*

I authorize Waynesburg Bible Chapel and it's representatives to render or obtain such emergency medical/treatment as may be necessary should injury, harm, or accident occur to my child while participating in this activity.

I agree to the terms & conditions

Photo Release

I give permission for my child(ren)s photo, both still and moving to be taken and used in press releases, brochures, video, websites and social media for publicity use and that this authorization will remain in effect in perpetuity. I understand that I have the right to revoke such authorization at any time by submitting written request.

I agree to the Photo release

Signature

By typing your name in the Signature Line you are electronically signing the form above.

Making sure you are real.*

Thanks for submitting!