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Join us for Wednesday Night Bible Clubs with AWANA!
Name *
Age *
Date of Birth *
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Grade *
Club *
Street Address
Zip Code
Email *
Parent/ Guardian *
Cell Phone Number *
Relationship to Child:
Person(s) authorized to pick up children: *
School District/ School Attending:
Church You Attend:
Emergency Contact Name *
Emergency Contact Phone *
Any known Allergies or illnesses? *
Anything else you want us to know so we can better serve your child?
The Registration Fee for the MJCOG AWANA Clubs is $35.00 per child per year. Clubs run from September thru early May. This covers your child’s vest/shirt, book, awards and prizes for the year. If you need scholarship assistance, please contact our AWANA Commander T.J. McNece at 801-928-1110 or the church office. *
Cubbies Uniform Size: (wears for 2 years)
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Sparks Uniform Size: (wears for 2 years)
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T & T Uniform (wears for 4 years):
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First Aid and Emergency Medical Treatment-- I recognize that there may be occasions where the child(ren) named above may be in need of first aid or emergency medical treatment as a result of accident, injury, illness or other health condition. I do hereby give permission for agents of Mount Joy Church of God to seek and secure any needed medical attention or treatment for the child(ren) named above including hospitalization if, in the agent’s opinion, such need arises. In doing so, I agree to pay all fees and costs arising from this action to obtain medical treatment. I give permission for attending physician(s) and other medical personnel to administer any needed medical treatment, including surgery. *
Release of Liability By signing this Permission and Waiver Form, I attest that the child(ren) named above are capable of withstanding both the physical and mental demands of the AWANA activities. I also expressly assume all risks to the child(ren) participating in the activities, whether such risks are known or unknown to me at this time. I further release Mount Joy Church of God and its ministers, leaders, employees, volunteers, and agents from any claim that my child(ren) may have against them as a result of injury or illness incurred during the course of participation in AWANA activities. This release of liability is also intended to cover all claims that members of the child(ren)’s or family or estate, heirs, representatives or assigns may have against the church or its ministers, leaders, employees, volunteers, or agents. I further agree to indemnify and hold harmless the church and its ministers, leaders, employees, volunteers, or agents from any and all claims arising from or as a result of injury or illness of my child(ren) during such activities. *
Photo Permission Form Mount Joy Church of God uses photos to promote ministries and events via the church webpage, facebook, printed publications, hallway bulletin boards, classroom displays, and AWANA Awards slideshow. Please indicate your permission with an X: *
I agree to the above statements regarding photo permission: *
By typing my name, I agree to signing electronically. I agree to the above statements regarding first aid and emergency medical treatment, release of liability, and photo permission: (please sign & date) *
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