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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.
Submit