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AWANA Online Registration

  1. Child's First Name(*)
    Please let us know your Child's First Name.
  2. Child's Last Name(*)
    Please let us know your Child's Last Name
  3. Child's Birthday(*)
    / / Invalid Input
  4. Child's Grade(*)
    Invalid Input
  5. Child's Shirt / Vest Size(*)
    Invalid Input
  6. Parent's (Guardian) Name(*)
    Invalid Input
  7. Parent's (Guardian) Email(*)
    Please let us know your email address.
  8. Street Address(*)
    Invalid Input
  9. Mailing Address(*)
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  10. City(*)
    Invalid Input
  11. State(*)
    Invalid Input
  12. Home Phone
    Invalid Input
  13. Mobile Phone(*)
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  14. Name of Church You Attend on Sundays
    Invalid Input
  15. In Case of Emergency and unable to reach parent, the following information would be used:
  16. Emergency Contact Name
    Invalid Input
  17. Emergency Contact Relationship to Child
    Invalid Input
  18. Emergency Contact Home Phone
    Invalid Input
  19. Emergency Contact Mobile Phone
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  20. Emergency Contact Street Address
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  21. Emergency Contact City
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  22. Emergency Contact State
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  23. Name of Insurance Company
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  24. Insured
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  25. Insurance I.D. Number
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  26. Insurance Group Number
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  27. Is there any special information that we need to know about your child?
    Invalid Input
  28. Upload a Current Picture of your Child (optional)
    Invalid Input
  29. Human Verification(*)
    Invalid Input
    This keeps us from receiving a bunch of spam from Internet bots :)

Contact Info

Phone:
870.239.2271

Fax:
870.239.4357

Email:
 home@southside-church.com

 

Address:
2211 Jones Road
Paragould, AR 72450

Website:
www.southside-church.com