SCBC Awana Registration

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Please submit one form per Awana clubber

Name *

First and last name of the student

Birthdate *

YYYY

Street Address *

City *

Zip *

Phone *

Grade *

School

Home Church

Which club are you registering your child for *

Cubbies 3 yrs - PreK

Sparks K-2nd Grade

T&T 3rd - 6th Grade

Parents or Guardian's Name *

Family Physician

Phone

Specific medical allergies, chronic illnesses, or other conditions *

Please type none if doesn't apply.

Emergency contact *

Name and Phone number

To whom it may concern: As parent and or guardian, I do hereby authorize the treatment by a qualified and licensed medical doctor of the above minor in the event of a medical emergency which, in the opinion of the attending physician, may endanger his/her life, cause disfigurement, physical impairment, or undue discomfort if delayed. This authority is granted only after a reasonable effort has been made to reach me. This release form is completed and signed of my own free will with the sole purpose of authorizing medical treatment under emergency circumstances in my absence for the Awana Club year, September 2014 thru May 2015. *

Typing your name is your electronic signature agreeing to the above statement.

Awana Dues and Fee

There are fees for books, shirts and vest. There are weekly dues as well which can be paid upfront for the entire year. More information about this will be given in person when you bring your child the first day.

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