Mt. Zion UMC Awana Registration Child Name * Date of Birth * Age * Year in School * PreschoolKindergarten1st2nd3rd4th5th6th Street Address * City * State * AKALARAZCACOCTDCDEFLGAHIIAIDILINKSKYLAMAMDMEMIMNMOMSMTNCNDNENHNJNMNVNYOHOKORPARISCSDTNTXUTVAVTWAWIWVWY Zip Code * Contact Number * Email Address (if available) Mother's Name Type HomeWorkCell Contact Number Father's Name Type HomeWorkCell Contact Number Name of Family Doctor Contact Number Emergency Contact * Emergency Contact Number * Is your family currently attending a church? * Yes No If so, what church are you attending? Does your child have any limiting health conditions? * Yes No List all conditions: Does your child have any allergies? * Yes No List all allergies: Are there any other special instructions for your child's care? * Yes No List other instructions: I give permission to the following individuals to pick up or drop off my child or ward at Awana: Permission to Pick Up Enter "N/A" if no other individuals have permission to drop off or pick up your child. I give permission for this child to be photographed at Awana by news media that could possibly publish their name and image. * Media Release * Yes No I give permission for this child to have his or her picture used to show Awana activities on the Mt. Zion United Methodist Church website without using first or last name. * Website/Social Media Release * Yes No Name of Person Submitting * If you are human, leave this field blank.
