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	ONLINE REGISTRATION     Students       First Name M.I.     Last Name     Street Address City State DC MD VA                  Zip Code       Gender Choose One Female Male     Upcoming Grade Choose One Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade 6th Grade 7th Grade or Above and Other       Date of Birth Month January February March April May June July August September October November December   Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31   Year 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004     How many years has student participated in AWANA? Choose One 0 1 2 3 4 5 6     Student Allergies     Student Health Insurance Choose One YES NO     If YES, Insurance Company  Name & Number     Parent / Guardian       First Name     Last Name     Email Address     Home Phone #     Work Phone #     Cell Phone #    By submiting this online registration, you and your child shall and hereby fully and unconditionally release, hold harmless and discharge AWANA Clubs International, Global Missions Church, AWANA chapter #8379 and their respective officers, directors, managers, agents, employees, representatives, or successors from any and all claims, demands, debts, damages, duties, causes of action, actions and suits whatsoever, in law or equity, on account of any act, failure to act, or event arising from, out of, or in any way related to, your child’s participation in AWANA.     By clicking the "I AGREE" button below and submitting this information, you acknowledge that you are the Parent or Guardian of the student listed above and that that you have read the liability waiver above and agree to abide by its terms.