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Southside Form
Awana 2026-2027 Registration
Kid's Information
Name
*
First Name
*
Last Name
*
Date of Birth
*
Gender
*
Select one
Female
Male
Allergies
Medical
Grade
*
Select one
3yr (Must be Potty Trained)
4yr
Kindergarten
1st
2nd
3rd
4th
5th
Emergency Contact
Name
*
Enter your first and last name.
First Name
*
Last Name
*
Phone Number
*
Relationship to child
*
Parent/Guardian Information
Parent One Name
*
Enter your first and last name.
First Name
*
Last Name
*
Parent Two Name
Enter your first and last name.
First Name
Last Name
Phone Number
*
Email Address
*
Address
*
Address Line 1
*
Address Line 2
City
*
State
*
Zip
*
Consent
*
This health history is correct so far as I know. I hereby give my permission to the licensed physician, nurse, or medical care provider designated by the group leader to secure medical aid as required for illness or injury under a physician's orders, including transportation to and from the necessary facilities. I understand I will be billed for any professional services rendered. I desire my child to participate in the Awana activities at Southside baptist Church for this club year. In consideration of Southside Baptist Church providing these activities, I do hereby release Southside Baptist Church, its officers, employees, agents, and Board members from all claims and causes of action by reason of an injury that may be sustained as a result of these church activities.
I give my consent as a parent/guarduian
I do not consent
Photo Release
I Hereby grant permission to Southside Baptist Church to use photographs and/or video taken at AWANA on social media, church websites affiliated with Southside Baptist Church, marketing for AWANA and in other communications related to promoting the mssion of Southside Baptist Church.
I grant permission
I do not grant permission
Order Contact
This is the parent, guardian, or payer who should receive payment and registration updates.
First Name
*
Last Name
*
Email
*
Phone
Payment Option
Pay in full
Your selection determines whether you pay the full amount now, place a deposit with one later balance payment, or use scheduled installment links.
Voucher Code
If the voucher covers the full amount, payment will be skipped and your registration will be marked scholarship.
Submit