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Awana Registration

Register your child today!

Register Today!

2024 AWANA Student Registration

"*" indicates required fields

Step 1 of 7

14%

Child's Information

Child's Name*

First Last

Address*

Street Address City 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

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sparks

sparks

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Cubbies

Cubbies

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T&T

T&T

This field is hidden when viewing the form

Journey

Journey

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Trek

Trek

School

Church Affiliation

Brought By

First Last

Parent's Information

Parent'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 State ZIP Code

Parent Primary Contact Number*

Parent Secondary Contact Number

May we contact you via SMS Messaging (Text Message)?*

Note: Standard text messaging rates apply

Yes

No

Medical Information

Please 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 Medications

Health 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 Agreement

Only 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 Registration

Is this your first time attending Cubbies?*

Yes

No

Cubbies Annual Dues

Price:

Cubbie Introduction Pack

Includes Workbook, Uniform Vest, & Book Bag

Price:

Cubbie Workbook

Note: A new Cubbie Workbook is required each year

Price:

Cubbie Required Products

Note: 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 Registration

Is this your first time attending Sparks?*

Yes

No

Sparks Annual Dues

Price:

Sparks Products

Note: 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 Pack

Includes 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 Registration

Is 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 Products

Note: 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 Registration

Is this your first time attending Trek?*

Yes

No

Trek Annual Dues

Price:

Trek Introduction Pack

Includes Workbook & Uniform

Price:

Trek Workbook

Note: A new Trek workbook is required each year

Price:

Trek Uniform

Note: 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 Registration

Is this your first time attending Journey?*

Yes

No

Journey Annual Dues

Price:

Journey Introduction Pack

Includes Workbook & Uniform

Price:

Journey Workbook

Note: A new Journey workbook is required each year

Price:

Journey Uniform

Note: 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 Fees

Total

To Complete Registration

Payment Method

Cash

Check

Credit Card

Other

Credit Card

Δ

ADDRESS
3331 Palo Verde Avenue
Long Beach, CA 90808

EMAIL
office@lbac.org

PHONE
(562) 420-1478

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