AWANA Student Registration "*" indicates required fields Step 1 of 7 14% Child's InformationChild's Name* First Last Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Gender* Boy Girl Age* Birthdate*Note: Child must be 3 years old by September 6, 2024 AND potty trained to begin Cubbies MM slash DD slash YYYY Grade* Preschool 4th Grade 9th Grade Kindergarten 5th Grade 10th Grade 1st Grade 6th Grade 11th Grade 2nd Grade 7th Grade 12th Grade 3rd Grade 8th Grade Cubbies: 30 Available Sparks: 50 Available T&T: 40 Available Trek: 25 Available Journey: 25 Available HiddensparkssparksTrueFalseHiddenCubbiesCubbiesTrueFalseHiddenT&TT&TTrueFalseHiddenJourneyJourneyTrueFalseHiddenTrekTrekTrueFalseSchool Church Affiliation Brought By First Last Parent's InformationParent's Name (Primary)* First Last Parent's Name (Secondary) First Last Email*Note: This is the email address through which all confirmations & notifications will be communicated. Enter Email Confirm Email Parent's Address (If different than Child's Address) Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Parent Primary Contact Number*Parent Secondary Contact NumberMay we contact you via SMS Messaging (Text Message)?*Note: Standard text messaging rates apply Yes No Medical InformationPlease Note: If you child needs to bring medication on campus or is required to take medication during AWANA program time, special arrangements will need to be made in writing with Meghan Brearley, Children's Ministry Director.Allergies / Disabilities / Current MedicationsHealth Insurance Provider* ID / Policy #* Phone Number of Medical Center or Physician*Physician's Name Is your child allergic to:* My child has no known allergies. Bee Stings Pollens Hay, Straw Penicillin Other Drugs Other Does your child have any life-threatening allergies?* Yes No My child is allergic to:* My child has life threatening allergies to:* Does your child have any physical, emotional, mental, or behavioral concerns or limitations that our staff should be aware of?* Yes No Please explain any physical, emotional, mental, or behavioral concerns or limitations our staff should be aware of:*Has your child ever had:* My child has none of the following conditions Seizures Asthma Diabetes Heart Disease Other My child has the following condition:* Emergency Contact Information (Other Than Parent)Name* First Last Phone Number*Relationship* Medical Release, Waiver of Liability, & Indemnity AgreementOnly the child's parent or legal guardian may sign this release. Your signature is represented by checked boxes. Please read the following statement(s) carefully and check the boxes below. All minors are required to have a parent or guardian's signature to attend The Long Beach Alliance AWANA Program. By checking the boxes on this electronic form you are agreeing to these written terms and conditions.I(we) the undersigned, acknowledge participation in, and/or give permission for, my(our) minor child to participate in AWANA provided by Long Beach Alliance Church September, 2024 - June, 2025. I(we) the undersigned confirm I(we) am(are) legally 18 years or older and sign on behalf of myself(ourselves) and on behalf of my(our) child.* Yes, I confirm and agree with these terms, and am signing this acknowledgement voluntarily. I(we) am(are) the parent(s) or legal guardian(s) of the minor listed above and grant my(our) permission for him/her to fully participate in Long Beach Alliance Church AWANA events and activities. These activities include, but are not limited to, competitive and strenuous group games; inflatable toys; swings and playground styled equipment; water balloon games; squirt gun and water spraying activities; food games; games played by crawling on floor; games played with balls, rackets, etc.; throwing or flying projectiles; and/or running. I(we) understand that my(our) child may be photographed or videotaped during activities and that these photos/videos may be used in promotional materials published by Long Beach Alliance Church.* Yes, I confirm and agree with these terms, and am signing this acknowledgement voluntarily. I(we) understand the Long Beach Alliance Church staff, volunteers, and AWANA leaders will make every attempt to contact me as soon as possible in the event an emergency arises. If contact cannot be made, I(we) authorize the Long Beach Alliance Church staff, volunteers, and AWANA leaders to provide medical care, and if necessary, take my child to a doctor or medical facility. I(we) also authorize medical treatment recommended by medical staff and I(we) assume responsibility for all medical costs.* Yes, I confirm and agree with these terms, and am signing this acknowledgement voluntarily. I(we), on behalf of my(our) child, myself, my children, my assigns, and my estate, assume the risk and promise to release from liability and hold harmless for personal injury or sickness and/or damage to personal or public property resulting from my(our) child’s participation, Long Beach Alliance Church, its officers, Governing Board, Elders, agents, employees, and/or volunteers for any and all claims for injuries, causes of action, or liability related to my and/or my minor child’s participation in any Long Beach Alliance Church AWANA onsite or offsite activity. This release does not apply to intentional and/or willful acts of misconduct, willful negligence, or lack of supervision by trained adult volunteer staff by Long Beach Alliance Church or any of its officers, Governing Board, Elders, agents, employees, and/or volunteers. I(we) agree to indemnify and hold harmless the Long Beach Alliance Church, its officers, Governing Board, Elders, agents, employees, and/or volunteers for any liability incurred or property damage/loss sustained by Long Beach Alliance Church as the result of the negligent, willful, or intentional conduct of my child, including expenses attendant thereto.* Yes, I confirm and agree with these terms, and am signing this acknowledgement voluntarily. Cubbies Fees & Payments for RegistrationIs this your first time attending Cubbies?* Yes No Cubbies Annual Dues Price: Cubbie Introduction PackIncludes Workbook, Uniform Vest, & Book Bag Price: Cubbie WorkbookNote: A new Cubbie Workbook is required each year Price: Cubbie Required ProductsNote: Each of these products is required for Cubbies. Please indicate which (if any) replacement products you need to order. Book Bag Cubbie Uniform Vest Cubbie Uniform Size Children's Small (4) Children's Medium (5) Children's Large (6) Children's Large (7) Children's XL (8) Children's XXL (10) Sparks Fees & Payments for RegistrationIs this your first time attending Sparks?* Yes No Sparks Annual Dues Price: Sparks ProductsNote: Each of these products is required for Sparks. Please indicate which (if any) replacement products you need to order. Workbook Sparky Uniform Vest Sparks Introduction PackIncludes Workbook & Uniform Vest Price: Sparks Uniform Size Children's Small (6) Children's Medium (8) Children's Large (10) Children's XL (12) Children's XXL (14) Children's XXXL (16) Optional Sparks Book Bag Quantity Price: $8.00 Quantity T&T Fees & Payments for RegistrationIs this your first time attending T&T?* Yes No T&T Annual Dues Price: T&T New Workbook Note: A new Workbook is required for T&T (even if you didn't finish last year's book). Price: T&T ProductsNote: Each of these products is required for T&T. Please indicate which (if any) replacement products you need to order. T&T Uniform T&T Uniform Size Youth Small (10) Youth Medium (12) Youth Large (14) Adult Small Adult Medium Adult Large Adult XL Adult XXL Adult XXXL T&T New Uniform Price: Optional T&T Book Bag Quantity Price: $15.00 Quantity Trek Fees & Payments for RegistrationIs this your first time attending Trek?* Yes No Trek Annual Dues Price: Trek Introduction PackIncludes Workbook & Uniform Price: Trek WorkbookNote: A new Trek workbook is required each year Price: Trek UniformNote: The uniform is required for Trek. Please indicate if you need to order a replacement uniform. Trek Uniform Trek Uniform Size Adult XS Adult S Adult M Adult L Adult XL Adult XXL Adult XXXL Optional Trek Book Bag Quantity Price: $15.00 Quantity Journey Fees & Payments for RegistrationIs this your first time attending Journey?* Yes No Journey Annual Dues Price: Journey Introduction PackIncludes Workbook & Uniform Price: Journey WorkbookNote: A new Journey workbook is required each year Price: Journey UniformNote: The uniform is required for Journey. Please indicate if you need to order a replacement uniform. Journey Uniform Journey Uniform Size Adult XS Adult S Adult M Adult L Adult XL Adult XXL Adult XXXL Optional Journey Book Bag Quantity Price: $15.00 Quantity Total FeesTotal To Complete RegistrationPayment Method Cash Check Credit Card Other Credit Card Δ