CBC AWANA 2018-2019
Thanks for signing your child(ren) up for AWANA. We are excited to have them as part of our team.
If you have MORE than 1 Child, we are asking that you fill out this form for each child, this will help expedite our ability to process their information. If there is an error in the information you've submitted or if you have questions, please contact Danny Kirk, Jr. 817.468.0083 ext. 220 or dkirk@cbcarlington.org.
Welcome To AWANA Club! Please Register Below.
Child's First Name *
Your answer
Child's Last Name *
Your answer
Child's Gender *
Child's Grade *
Child's Birthdate *
MM
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DD
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YYYY
Does this child have allergies or special needs? *Simply type "Yes" or "No." If "Yes," please explain. *
Your answer
Parent or Guardian First Name *
Your answer
Parent or Guardian Last Name *
Your answer
Parent or Guardian Phone Number *
Your answer
Address *
Your answer
City, State, Zip *
Your answer
Email Address *
Your answer
Emergency Contact Name (in case parent/guardian is unavailable) *
Your answer
Emergency Contact Phone Number (in case parent/guardian is unavailable) *
Your answer
Are you a member of Cornerstone Church or a visitor? *
Any restrictions of activity due to medical reasons? Please explain.
Your answer
Any behavioral concerns? Please explain.
Your answer
We Take Pictures and Video For Promotional Purposes
Photos/Videos may be used for educational or promotional purposes on publicly distributed printed materials, within the Cornerstone facility, or online, including our website, Facebook and other social media outlets. Understand that global access to the internet does not allow us to control who may access the photos or videos.
Do you give permission for your child to be photographed/filmed? *
Liability Waiver
1.) I consent to and approve my child/children’s taking part in any and all activities conducted by CORNERSTONE CHURCH AWANA Clubs. I understand that my child/children may participate in physical activities such as those held during Game Time. As with any physical activity, there is a risk of injury. I fully accept this risk and consent to the treatment of any minor injuries of my child/children, and release, hold harmless and indemnify AWANA, Cornerstone Church and their officers, directors, agents, employees and volunteers from any and all liability, claims and costs arising from or growing out of such treatment. In the event of an emergency that requires medical treatment for the above named child/children, I understand every effort will be made to contact me or my emergency contact. However, if I/we cannot be reached, I give my permission to the AWANA volunteers to secure the services of a licensed physician to provide the care necessary for my child’s well being. I assume responsibility for all costs connected to any accident or treatment of my child.

2.) I understand that any off-property AWANA excursions will be communicated with me beforehand and I will be required to sign a separate medical release form in order for my child to participate in those excursions.

3.) 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 Cornerstone. 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. *
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