RM_StatsGeneral InformationThis year Summer AWANA will be held on Wednesday Nights 6-8pm through June and July. We will meet June 6th, 13th, 27th, July 11th, and 18th. Doors will open each week at 5:45pm.Child's First NameChild's Last NameChild's Birth DateSchool GradeSelect an optionPre-KK123456NAGrade based upon what grade they were in during the 2020-2021 school year.Which group will your child be in?Select an optionCubbies (3-5 yo)Sparks (K-2 grade)T&T (3-6 grade)Grade based on which grade they were in the 2020-2021 school year.Bus Rider to and from AWANA? Yes No Family Address Address Line 1 Address Line 2 City State or Region Alabama Alaska Arizona Arkansas Armed Forces America Armed Forces Europe Armed Forces Pacific California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State or Region Country Zip Parent's Email *Information will be sent via email. Home PhoneCell PhoneTexting? Yes No Emergency InformationEmergency information for who will be contacted if parents cannot be reached. Emergency Contact #1:Please include the contact's name, their relationship to your child, and their phone number.Emergency Contact #2Please include the contact's name, their relationship to your child, and their phone number.PhysicianPlease include the child's physician's name and contact phone numberMedical ConditionsPlease include any allergies, special needs, and/or instructions.LiabilityMedical & Liability Release - Valid June 2021 - July 2021I agreeI agreeIn the event of sickness or medical emergency, I request that my child receive any medical attention or treatment deemed necessary. Therefore, I give permission to any hospital, doctor, and/or health care provider to transport, treat, and/or admit for care my child. In the event that I am not present at the time of the emergency or cannot be contacted, care for my child has been entrusted to the staff and designated ministry leadership of Mt. Zion Baptist Church.Today's DatePlease enter today's date.PhotoPhoto Publishing ReleasePhoto Publishing ReleaseI agreeI give permission for Mt. Zion Baptist Church to use the photo or video of my child on the Mt. Zion Baptist Church and AWANA Facebook pages and the church website.Today's DateT shirt sizeChild's T-Shirt sizeSelect an optionYouth X-SmallYouth SmallYouth MediumYouth LargeAdult SmallAdult MediumAdult LargeAdult X-Large Note: It looks like JavaScript is disabled in your browser. Some elements of this form may require JavaScript to work properly. If you have trouble submitting the form, try enabling JavaScript momentarily and resubmit. JavaScript settings are usually found in Browser Settings or Browser Developer menu.
