RCCC Awana Registration Form 2018-2019
One Year Program
Clubber's Last Name *
Your answer
Clubber's First Name *
Your answer
Parent's Last Name *
Your answer
Parent's First Name *
Your answer
Name of Parent's Small Group below? (Please put N/A if you don't attend any small group in RCCC) *
Your answer
Clubber's Birthday *
Your answer
Boy Or Girl
Grade *
Home Address *
Your answer
Contact Number *
000-0000000
Your answer
Email Address *
Your answer
Emergency Contact Person *
Your answer
Emergency Contact Number *
000-0000000
Your answer
Medical or other information we need to know?( Please include any food allergies) *
Your answer
Club and registration Information *
The $50 registration fee cover clubs dues from 9/2018 to 6/2019 semester
Uniform Information (Select N/A if you have Uniform from last year) *
Please select the new Uniform Size and pay $10 if you are first time or you need a new uniform.
Parents *
We rely on parents and other volunteers to staff our club. We will contact you about serving. Which job are you interested in? (please choose at least one option)
Required
Do Clubber attend Sunday School?
If so, Where?
Your answer
If you are visiting our church, who are you a guest of?
Your answer
May we have permission to photograph your child? *
May we have permission to use your child's photograph in church publications for the purpose of promotion? *
Liability Release ( Must be signed by a parent/guardian) *
I hereby authorize the volunteers and staff as my Agents to consent to medical, surgical, or dental examination or treatment in the case of an emergency. I also hereby authorize treatment and/or care at any hospital. I hereby release, discharge, and hold harmless Raleigh Chinese Christian Church, its employees, volunteers, and other representatives from any claims arising out of or relating to the decisions made while acting as my Agent in these respects during this activity.
Signature of Parent/Guardian *
Please print your name here and bring your payment to our Awana Staffs
Your answer
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