2018-2019 AWANA Registration Form
Please enter the following information if you would like your child to join AWANA at FCBC. Parents must submit and sign a registration form for each child to participate. Registration fee of $30 per child will be collected anytime before or on Child's first AWANA night. Please make checks payable to "FCBC" with "AWANA" and child's name on the memo line. AWANA starts on September 7th at 7:30pm.
Email address *
Child's first and last name *
Your answer
Child's Primary Language *
Your answer
Child's grade (Fall 2018) *
Your answer
Child's birth date (must be at least 3 years old by Sept. 1st to participate in AWANA) *
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Child's food allergies *
Your answer
Parent's First & Last name *
Your answer
Cell phone number *
Your answer
Home address (street and zip code) *
Your answer
Any comments/questions/notes/important info *
Your answer
MEDICAL RELEASE ON BEHALF OF MINOR AND HOLD HARMLESS AGREEMENT
1.) My child/children may be giving reasonable emergency medical treatment in connection with all church events, and I authorize the person(s) in charge of the activity to administer, arrange for, and authorize such emergency medical care and treatment in my place and stead. I knowingly and voluntarily WAIVE AND RELEASE all claims and causes of action of any kind whatsoever (other than for gross negligence or willful misconduct) against FCBC, its elders, pastors, officers, staff and volunteers, which I or my child/children may hereafter have by reason of or relating to my child/children’s participation at FCBC including injury, illness, or death of my child/children and damage to any property or the property of my child/children. I UNDERSTAND THAT THE CLAIMS AND CAUSES OF ACTION HEREBY WAIVED AND RELEASED INCLUDE THOSE BASED IN WHOLE OR IN PART, ON THE ORDINARY NEGLIGENCE (BUT NOT GROSS NEGLIGENCE OR WILLFUL MISCONDUCT) OF FCBC, ITS ELDERS, PASTORS, OFFICERS, STAFF OR VOLUNTEERS.

2.) I give permission for photo(s) of my child/children to appear among other general club photos in any and all media as long as there is no identifying information published by FCBC. I hereby waive any causes of action I may have because of the use of my child’s photograph.

I have read and agree to the Terms and Conditions stated above.

E-Signature and date *
Your answer
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